Association between hyperglycemia and organ dysfunction in shock patients
Keywords:
hyperglycemia, shack, organ dysfunction, PRISM III score, PELOD score
Abstract
Background Hyperglycemia is an important marker of bothpoor clinical outcomes and high mortality rate in critically ill
patients. Glucose toxicity results in cell damage that leads to
organ dysfunction.
Objective To evaluate for an association between hyperglycemia
and the incidence of organ dysfunction in shock patients.
Methods This cross-sectional study was conducted in the
pediatric intensive care unit (PICU) of Dr. Moh. Hoesin
Hospital, Palembang from June to November 2011. Subjects
were consecutively-enrolled, shock patients without a history
of diabetes mellitus. Illness severity and organ dysfunction were
determined by pediatric risk of mortality (PRISM) III score and
pediatric logistic organ dysfunction (PELOD) scores, respectively.
Hyperglycemia was defined as a blood glucose level 2: 110 mg/dL.
Statistical analysis was performed with SPSS version 15.
Results Mean age of subjects was 2.30 (SD 2.93) years. Mean
PRISM III score was 15 .11 (SD 5 .63). Prevalence of hyperglycemia
was 80.0%. Mean glucose level was 179.51 (SD 86.84) mgldL.
Mean PELOD score was 16.02 (SD 13.87). Organ dysfunction was
observed in 86.7% of subjects. The most common organ dysfunction
observed in our subjects was liver dysfunction (73.3%). There
was a significant association between hyperglycemia and organ
dysfunction (OR43.750;95%CI 4.036 to474.252, P=0.001). The
blood glucose level cutoff points indicative of organ dysfunction,
PRISM III score 2: 8, and PELOD score 2: 20.5 were 114.5 mg/
dL, 129 mgldL, and 166 mg/dL, respectively.
Conclusion There is an association between hyperglycemia and
organ dysfunction. The upper limit blood glucose level indicative of
organ dysfunction is 114.5 mg/dL. A glucose level of 129 mgldL may
be considered to be a warning to start blood glucose monitoring. A
level above 166 mgldL may be used to indicate the necessity of starting
insulin therapy intervention.
References
1. Gupta P, Natarajan G, Agarwal KN. Transient hyperglycemia
in acute childhood illnesses: to attend or ignore? Indian J
Pediatr. 1997;64:205-10.
2. Van den Berghe G, Wilmer A, Hermans G, Meersseman W,
Wouters PJ, Milants I, et al. Intensive insulin therapy in the
medical ICU. N EnglJ Med. 2006;354:449-61.
3. Garcia VA. The association between glycemia and outcomes
in critically ill patients. UT Health science center department
of pediatrics. 2009 Sept ll;l-6. Available from: http://www.
pediatrics. uthscsa.edu/grandrounds/handouts/2009-09-1 I
4. Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA,N adkami V Association of timing, duration, and intensity of
hyperglycemia with intensive care unit mortality in critically
ill children. Pediatr Crit Care Med. 2004;5:329-36.
5. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ,
Kache S, Wilson DM. Association of hypoglycemia,
hyperglycemia, and glucose variability with morbidity
and death in the pediatric intensive care unit. Pediatrics.
2006;118: 173-9.
6. Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ
dysfunction is associated with hyperglycemia in critically ill
children. Pediatric critical care medicine. 2010;36:312-20.
7. Yung M, Wilkins B, Norton L, Slater A. Glucose control,
organ failure, and mortality in pediatric in tensive care. Pediatr
Crit Care Med. 2008;9:147-52.
8. Branco RG, Garcia PC, Piva JP, Casartelli CH, Seibel V, Tasker RC. Glucose level and risk of mortality in pediatric
septic shock. Pediatr Crit Care Med. 2005;6:4 70-2.
9. Poddar B. Treating hyperglycemia in the critically ill child: is
there enough evidence? Indian Pediatr. 2011;48:531-6.
10. Van den Berghe G, Wouters P, Weekers F, Verwaest C,
Bruyninckx F, Schetz M, et al. Intensive insuline therapy in
critically ill patients. N Engl J Med. 2001;345:1359-67.
11. Ali NA, O'Brien JM, Dungan K, Phillips G, Marsh CB,
Lemeshow S. Glucose variability and mortality in patients
with sepsis. Crit Care Med. 2008;36:2316-21.
12. Grau T, Bonet A. Caloric intake and liver dysfunction in
critically ill patients. Curr Opin Clin Nutr Metab Care.
2009;12:175-9.
in acute childhood illnesses: to attend or ignore? Indian J
Pediatr. 1997;64:205-10.
2. Van den Berghe G, Wilmer A, Hermans G, Meersseman W,
Wouters PJ, Milants I, et al. Intensive insulin therapy in the
medical ICU. N EnglJ Med. 2006;354:449-61.
3. Garcia VA. The association between glycemia and outcomes
in critically ill patients. UT Health science center department
of pediatrics. 2009 Sept ll;l-6. Available from: http://www.
pediatrics. uthscsa.edu/grandrounds/handouts/2009-09-1 I
4. Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA,N adkami V Association of timing, duration, and intensity of
hyperglycemia with intensive care unit mortality in critically
ill children. Pediatr Crit Care Med. 2004;5:329-36.
5. Wintergerst KA, Buckingham B, Gandrud L, Wong BJ,
Kache S, Wilson DM. Association of hypoglycemia,
hyperglycemia, and glucose variability with morbidity
and death in the pediatric intensive care unit. Pediatrics.
2006;118: 173-9.
6. Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ
dysfunction is associated with hyperglycemia in critically ill
children. Pediatric critical care medicine. 2010;36:312-20.
7. Yung M, Wilkins B, Norton L, Slater A. Glucose control,
organ failure, and mortality in pediatric in tensive care. Pediatr
Crit Care Med. 2008;9:147-52.
8. Branco RG, Garcia PC, Piva JP, Casartelli CH, Seibel V, Tasker RC. Glucose level and risk of mortality in pediatric
septic shock. Pediatr Crit Care Med. 2005;6:4 70-2.
9. Poddar B. Treating hyperglycemia in the critically ill child: is
there enough evidence? Indian Pediatr. 2011;48:531-6.
10. Van den Berghe G, Wouters P, Weekers F, Verwaest C,
Bruyninckx F, Schetz M, et al. Intensive insuline therapy in
critically ill patients. N Engl J Med. 2001;345:1359-67.
11. Ali NA, O'Brien JM, Dungan K, Phillips G, Marsh CB,
Lemeshow S. Glucose variability and mortality in patients
with sepsis. Crit Care Med. 2008;36:2316-21.
12. Grau T, Bonet A. Caloric intake and liver dysfunction in
critically ill patients. Curr Opin Clin Nutr Metab Care.
2009;12:175-9.
Published
2013-02-28
How to Cite
1.
Noberta S, Triratna S, Aditiawati A, Husin S. Association between hyperglycemia and organ dysfunction in shock patients. PI [Internet]. 28Feb.2013 [cited 22Nov.2024];53(1):26-1. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/244
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Received 2016-08-18
Accepted 2016-08-18
Published 2013-02-28
Accepted 2016-08-18
Published 2013-02-28
