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Eliotte L. Hirshberg, MD*; Stacey Knight; Gitte Y. Larsen, MD
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University of Utah, Salt Lake City, UT


Chest. 2005;128(4_MeetingAbstracts):217S. doi:10.1378/chest.128.4_MeetingAbstracts.217S
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PURPOSE:  Hyperglycemia in critically ill, non-diabetic adults is associated with increased morbidity and mortality. The natural course of hyperglycemia in a heterogeneous population of critically ill children and its association with mortality is unknown. Our study documents the natural history of hyperglycemia in a university-affiliated, multidisciplinary pediatric intensive care unit (PICU) population.

METHODS:  We performed a retrospective cohort analysis of all admissions to a 28 bed PICU during the year 2003. Computerized hospital admission records and hospital laboratory database of all patients admitted to a PICU for greater than 24 hours with at least a single blood glucose level were included. The 1250 patients were stratified by diagnostic code groups. We performed bivariate analysis of hyperglycemia, defined by a threshold of 150 mg/dL, mortality, and length of stay.

RESULTS:  Hyperglycemia was identified in 494/1250 (39.5%) patients. Glucose values peaked during the first 12 hours of PICU admission. The 2003 mortality rate for this cohort was 39/1250 (3.1%). The risk of hospital mortality for patients with hyperglycemia was 13.4 times higher than those patients with normoglycemia (95% CI: 4.8-37.5). The average of maximum glucose values over the PICU hospital stay was significantly higher among non-survivors (296 mg/dL) than survivors (147 mg/dL) (p<0.001). The median hospital length of stay for patients with hyperglycemia was 3.2 days compared to 2.3 days for patients with normoglycemia (p<0.001).

CONCLUSION:  Hyperglycemia in the critically ill, pediatric population occurs frequently, peaks in the first 24 hours, and is associated with an increased hospital mortality and length of stay.

CLINICAL IMPLICATIONS:  Although mortality in the critically ill pediatric population is low, management of hyperglycemia in a subset of critically ill children may be as important as controlling hyperglycemia in critically ill adults. A large prospective trial of standardized glucose control in critically ill children is warranted. PICU Diagnostic GroupNo.(%)of Patients With Hyperglycemia (>150 mg/dl)Cardiovascular surgery150/242 (62)Sepsis40/66 (61)Respiratory failure374/704 (53)Traumatic brain injury 7/19 (37)

Patients may be in more than one category

DISCLOSURE:  Eliotte Hirshberg, None.

10:30 AM - 12:00 PM




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