Etiology of hyperglycemia in critically ill children and the impact of organ dysfunction

ABSTRACT Objective: This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. Methods: This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission. Homeostasis model assessment was used to assess β-cell function and insulin sensitivity. Results: Hyperglycemia was estimated in 70% of patients. Blood glucose values ≥ 180mg/dL were associated with a poor outcome. Blood glucose levels were positively correlated with Pediatric Risk for Mortality (PRISM III) score and number of organ dysfunctions (p = 0.019 and p = 0.022, respectively), while insulin levels were negatively correlated with number of organ dysfunctions (r = −0.33, p = 0.01). Homeostasis model assessment revealed that 26 (43.3%) of the critically ill patients had low β-cell function, and 18 (30%) had low insulin sensitivity. Combined pathology was detected in 2 (3.3%) patients only. Low β-cell function was significantly associated with the presence of multi-organ dysfunction; respiratory, cardiovascular, and hematological dysfunctions; and the presence of sepsis. Conclusions: β-Cell dysfunction appeared to be prevalent in our cohort and was associated with multi-organ dysfunction.

摘要：
研究目的：本研究旨在探讨重症患儿应激性高血糖（stress hyperglycemia）的发病率，并基于稳态模型评估（Homeostasis model assessment）法探究该高血糖的病因学基础。
方法：本研究为一项前瞻性队列研究，于开罗大学儿科重症监护病房开展，共纳入60名重症患儿与21名健康对照者。于患儿入院24小时内检测其血清血糖、胰岛素及C肽水平，并采用稳态模型评估法评估β细胞功能与胰岛素敏感性。
结果：本研究结果显示，70%的受试患者存在高血糖症状。血糖值≥180mg/dL与不良预后显著相关。血糖水平与儿童死亡风险评分（Pediatric Risk for Mortality, PRISM III）及器官功能障碍数量呈正相关（分别为p=0.019与p=0.022）；而胰岛素水平与器官功能障碍数量呈负相关（r=-0.33，p=0.01）。稳态模型评估结果表明，60名重症患儿中有26例（43.3%）存在β细胞功能低下，18例（30%）存在胰岛素敏感性降低，仅2例（3.3%）患者同时存在上述两种病理异常。β细胞功能低下与多器官功能障碍（呼吸系统、心血管系统及血液系统功能障碍）及脓毒症的发生显著相关。
结论：本研究队列中β细胞功能障碍较为普遍，且与多器官功能障碍密切相关。