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

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)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Pediat, Discipline Nutr & Metab, BR-04040032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Pediat Intens Care Unit, BR-04040032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04040032 São Paulo, BrazilUniv São Paulo, Inst Crianca, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Discipline Nutr & Metab, BR-04040032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Pediat, Pediat Intens Care Unit, BR-04040032 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Surg, BR-04040032 São Paulo, BrazilWeb of Scienc