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.
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.
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).
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.
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 Group†No.(%)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
Eliotte Hirshberg, None.