Introduction: In adults, strict control of hyperglycemia reduces
mortality and morbidity. There is controversy in medical patients
and neurological patients who can suffer of neuroglucopenia.
Objectives: To determine prevalence and prognostic significance
of hyperglycemia among critically ill non-diabetic children.
To evaluate which patients will best benefit of insulin
treatment.
Methods: Retrospective study using blood glucose levels
(GLUC: 9015 values, 923 patients) in our PICU from 01.2003
to 12.2005. 11 Patients with DKA were excluded. Overall
PICU mortality was 3.7%. Hyperglycemia was defined at 6.1
mmol/L and different cutoff values (6.1, 8.3 and 11.1 mmol/l)
were analyzed for glycemia at admission (GLUC). Sustained
hyperglycemia was evaluated with the area under the curve
normalized per hour (48h-AUC/h) for the first 48 h. The prevalence
of hypo (_3mmol/L), hyperglycemia and PICU death
were analyzed.
Results: Trough the use of different cutoff values (_6.1, _8.3 and
_11.1 mmol/l), prevalence of hyperglycemia at admission was 31.8
%, 16.8% and 10.3%; associated mortality was 2.8%, 4.0% and
15.2% respectively, significantly correlated to cutoff values (r_0.95,
p_0.05). Prevalence of hypoglycemia at admission was low (0.9%
with no death). 48h-AUC(mmol/L/h) was computed in 747 children
(30 deaths). Prevalence of hyperglycemic 48h-AUC values was
47.5%, 17.3% and 4.0% with a respective mortality of 3.4%, 6.3%
and 20.7% (r_0.97, p_0.03). For those with high GLUC and high
48h-AUC (_ 11.1 mmol/L) mortality was high (31.5%), but it decrease
dramatically to 5.5% when 48h-AUC decrease spontaneously
to values _8.3 mmol/L/h. Finally, when patients with severe
neurological lesions (GCS_3, n_22) where excluded, increased
mortality was observed only for GLUC (n_ 86) and 48h-AUC
(n_26) higher than 11.1 mmol/L.
Conclusions: Hyperglycemia at admission and even more sustained
hyperglycemia (AUC) are highly correlated to mortality in
PICU. But children who will have benefit of insulin therapy represent
only 3% of our population, much lower than for adults.