Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children

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Abstract
To study the association of timing, duration, and intensity of hyperglycemia with pediatric intensive care unit (PICU) mortality in critically ill children. Retrospective cohort study. PICU of a university-affiliated, tertiary care, children's hospital. A total of 152 critically ill children receiving vasoactive infusions or mechanical ventilation. None. With institutional review board approval, we reviewed a cohort of 179 consecutive children, 1 mo to 21 yrs of age, treated with mechanical ventilation or vasoactive infusions. We excluded 18 with 126 mg/dL), and intensity of hyperglycemia (median BG during first 48 PICU hours) were analyzed for association with PICU mortality using chi-square, Student's t-test, and logistic regression. Peak BG of >126 mg/dL occurred in 86% of patients. Compared with survivors, nonsurvivors had higher peak BG (311 ± 115 vs. 205 ± 80 mg/dL, p < .001). Median time to peak BG was similar in nonsurvivors (23.5 hrs; interquartile ratio, 5–236 hrs) and survivors (19 hrs; inter-quartile ratio, 6–113 hrs). Duration of hyperglycemia was longer in nonsurvivors (71% ± 14% of PICU days) vs. survivors (37% ± 5% of PICU days, p < .001). Nonsurvivors had more intense hyperglycemia during the first 48 hrs in the PICU (126 ± 38 mg/dL) vs. survivors (116 ± 34 mg/dL, p < .05). Univariate logistic regression analysis showed that peak BG and the duration and intensity of hyperglycemia were each associated with PICU mortality (p < .05). Multivariate modeling controlling for age and Pediatric Risk of Mortality scores showed independent association of peak BG and duration of hyperglycemia with PICU mortality (p < .05). Hyperglycemia is common in critically ill children. Peak BG and duration of hyperglycemia are independently associated with mortality in our PICU. A prospective, randomized trial of strict glycemic control in this subset of critically ill children who are at high risk of mortality is both warranted and feasible.