Assessment of Glucose Homeostasis in Critically ill Children - Abstract
Background: Abnormal blood glucose concentration is the most common metabolic abnormality in childhood particularly in critically ill children. High blood glucose (BG) levels have shown an association with poor outcomes in critically ill patients. Method: A cross-sectional study was carried on 100 critically ill infants and children admitted to the Pediatric Intensive Care Unit (PICU), Menoufia University Hospital diagnosed as critically ill according to WHO guidelines. Pediatric Sequential Organ Failure assessment Score (pSOFA) and Pediatric Risk of Mortality (PRISM) were performed for all patients. PICU stay, PRISM score, pSOFA score and death in PICU were outcomes of the research. All children included in the study subjected to blood glucose sampling at admission, at 24 hours and at 48 hours. Results: Most of the studied patients had hypoglycemia (20%) and 22% had normal blood glucose level, while 58% had hyperglycemia. Statistically significant increase in hyperglycemia group than other groups regarding PICU stay, hospital stay, pSOFA score, PRISM score and death in PICU. Also statistically significant relation between mean glycemic lability index with PICU stay (p=0.025), PRISM score (p=0.019), pSOFA score (p=0.038) and death in PICU (p=0.041), which were increased among hyperglycemic patients followed by hypoglycemic patients than normal group. These outcomes were significantly increased with increased of glucose variability. Blood glucose is an independent and significant predictor of mortality among the studied patients with sensitivity (91.3%), specificity (85.7%), positive predictive value (68%) and negative predictive value (35%). Conclusion: Blood glucose was significantly positive relation with hospital stay, PICU stay, PRISM score and pSOFA score. Mean glycemic lability index was related with PICU stay, PRISM score, pSOFA score and death in PICU, which were increased among hyperglycemic patients followed by hypoglycemic patients than normal group.