Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia

Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia

Author Leite, Heitor Pons Autor UNIFESP Google Scholar
Lima, Lucio Flavio Peixoto de Autor UNIFESP Google Scholar
Iglesias, Simone Brasil de Oliveira Autor UNIFESP Google Scholar
Pacheco, Juliana Cristina Autor UNIFESP Google Scholar
Carvalho, Werther Brunow de Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Universidade de São Paulo (USP)
Abstract Objectives: To determine whether hyperglycemia and hypoglycemia are associated with higher mortality, longer length of intensive care unit (ICU) stay, and fewer ventilator-free days in critically ill children while taking into account the clinical severity and nutrition status. Patients and Methods: A prospective observational cohort study was conducted on 221 children admitted to the ICU. Blood glucose levels were analyzed in the first 72 hours. Potential exposure variables for adverse prognosis included hyperglycemia (blood glucose > 150 mg/dL), hypoglycemia (blood glucose <= 60 mg/dL), age < 1 year, sex, nutrition status, the revised Pediatric Index of Mortality (PIM 2), and the Pediatric Logistic Organ Dysfunction (PELOD). Results: of the patients, 47.1% were malnourished. Controlling for nutrition status, both hyperglycemia and hypoglycemia increased the risk of mortality in the malnourished patients compared with the well-nourished ones. Adjusting for clinical severity, the odds ratio of mortality was higher in malnourished patients with hyperglycemia (odds ratio [OR], 3.98; 95% confidence interval [CI], 1.14-13.94; P = .03), whereas no significant associations were detected in the well-nourished patients. After controlling for nutrition status, hypoglycemia was associated with longer length of ICU stay (OR, 6.5; 95% CI, 1.30-32.57; P < .01) and fewer ventilator-free days (OR, 4.11; 95% CI, 1.26-13.40; P < .01) only in the malnourished group of patients. Conclusions: Compared with the well nourished, malnourished patients with hyperglycemia are at a greater risk of mortality, independent of clinical severity. Hypoglycemia was shown to be associated with mortality, longer length of ICU stay, and fewer ventilator-free days only in malnourished patients. (JPEN J Parenter Enteral Nutr. 2013;37:335-341)
Keywords blood glucose
intensive care units
risk factors
Language English
Sponsor Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Date 2013-05-01
Published in Journal of Parenteral and Enteral Nutrition. Thousand Oaks: Sage Publications Inc, v. 37, n. 3, p. 335-341, 2013.
ISSN 0148-6071 (Sherpa/Romeo, impact factor)
Publisher Sage Publications Inc
Extent 335-341
Access rights Closed access
Type Article
Web of Science ID WOS:000317987600007

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