Etiology of hyperglycemia in critically ill children and the impact of organ dysfunction
| Autor: | Seham Awad El-Sherbini, Riham El-Sayed, Sarah Hosam-ElDin, Huda Marzouk |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Blood Glucose
Male medicine.medical_treatment Critical Care and Intensive Care Medicine Stress hyperglycemia Cohort Studies 0302 clinical medicine Insulin-Secreting Cells Homeostasis Insulin Resistência a insulina Prospective Studies Prospective cohort study Child C-Peptide Incidence General Medicine Child Preschool Original Article Egypt Female medicine.symptom Cohort study medicine.medical_specialty Critical Illness Multiple Organ Failure Criança Intensive Care Units Pediatric Sepsis 03 medical and health sciences Homeostase Stress Physiological 030225 pediatrics Intensive care Internal medicine medicine Humans Estado terminal business.industry Hyperglycemia/etiology Organ dysfunction Case-control study Infant 030208 emergency & critical care medicine Insulin resistance medicine.disease Case-Control Studies Hyperglycemia Hiperglicemia/etiologia Critical illness business |
| Zdroj: | Revista Brasileira de Terapia Intensiva Revista Brasileira de Terapia Intensiva, Volume: 30, Issue: 3, Pages: 286-293, Published: SEP 2018 |
| ISSN: | 1982-4335 |
| Popis: | RESUMO Objetivo: Verificar a incidência da hiperglicemia de estresse em crianças em condição grave e investigar a etiologia da hiperglicemia com base em um modelo de avaliação da homeostasia. Métodos: Estudo prospectivo de coorte, conduzido em uma unidade de terapia intensiva pediátrica da Cairo University, que incluiu 60 crianças com doença grave e 21 controles saudáveis. Utilizaram-se os níveis séricos de glicose, insulina e peptídeo C, avaliados em até 24 horas após a admissão. O modelo de avaliação da homeostasia foi utilizado para analisar a função das células beta e a sensibilidade à insulina. Resultados: A hiperglicemia foi estimada em 70% dos pacientes. Valores de glicemia ≥ 180mg/dL se associaram com desfechos piores. Os níveis de glicemia se correlacionaram de forma positiva com o Pediatric Risk for Mortality (PRISM III) e o número de órgãos com disfunção (p = 0,019 e p = 0,022, respectivamente), enquanto os níveis de insulina se correlacionaram de forma negativa com o número de órgãos com disfunção (r = -0,33; p = 0,01). O modelo de avaliação da homeostasia revelou que 26 (43,3%) das crianças em condições graves tinham baixa função de células beta e 18 (30%) baixa sensibilidade à insulina. Detectou-se patologia combinada em apenas dois (3,3%) pacientes. Baixa função de células beta se associou de forma significante com a presença de disfunção de múltiplos órgãos, disfunção respiratória, cardiovascular e hematológica, e presença de sepse. Conclusões: A disfunção de células beta pareceu ser prevalente em nossa coorte e se associou com disfunção de múltiplos órgãos. ABSTRACT Objective: This study aimed to study the incidence of stress hyperglycemia in critically ill children and to investigate the etiological basis of the hyperglycemia based on homeostasis model assessment. Methods: This was a prospective cohort study in one of the pediatric intensive care units of Cairo University, including 60 critically ill children and 21 healthy controls. Serum blood glucose, insulin, and C-peptide levels were measured within 24 hours of admission. Homeostasis model assessment was used to assess β-cell function and insulin sensitivity. Results: Hyperglycemia was estimated in 70% of patients. Blood glucose values ≥ 180mg/dL were associated with a poor outcome. Blood glucose levels were positively correlated with Pediatric Risk for Mortality (PRISM III) score and number of organ dysfunctions (p = 0.019 and p = 0.022, respectively), while insulin levels were negatively correlated with number of organ dysfunctions (r = −0.33, p = 0.01). Homeostasis model assessment revealed that 26 (43.3%) of the critically ill patients had low β-cell function, and 18 (30%) had low insulin sensitivity. Combined pathology was detected in 2 (3.3%) patients only. Low β-cell function was significantly associated with the presence of multi-organ dysfunction; respiratory, cardiovascular, and hematological dysfunctions; and the presence of sepsis. Conclusions: β-Cell dysfunction appeared to be prevalent in our cohort and was associated with multi-organ dysfunction. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|