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Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia.
JPEN J Parenter Enteral Nutr 2013 May-Jun; 37(3):335-41JJ

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.

Authors+Show Affiliations

Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil. heitorpons@gmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22930337

Citation

Leite, Heitor Pons, et al. "Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 37, no. 3, 2013, pp. 335-41.
Leite HP, de Lima LF, de Oliveira Iglesias SB, et al. Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia. JPEN J Parenter Enteral Nutr. 2013;37(3):335-41.
Leite, H. P., de Lima, L. F., de Oliveira Iglesias, S. B., Pacheco, J. C., & de Carvalho, W. B. (2013). Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia. JPEN. Journal of Parenteral and Enteral Nutrition, 37(3), pp. 335-41. doi:10.1177/0148607112458124.
Leite HP, et al. Malnutrition May Worsen the Prognosis of Critically Ill Children With Hyperglycemia and Hypoglycemia. JPEN J Parenter Enteral Nutr. 2013;37(3):335-41. PubMed PMID: 22930337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Malnutrition may worsen the prognosis of critically ill children with hyperglycemia and hypoglycemia. AU - Leite,Heitor Pons, AU - de Lima,Lúcio Flávio Peixoto, AU - de Oliveira Iglesias,Simone Brasil, AU - Pacheco,Juliana Cristina, AU - de Carvalho,Werther Brunow, Y1 - 2012/08/28/ PY - 2012/8/30/entrez PY - 2012/8/30/pubmed PY - 2014/1/3/medline SP - 335 EP - 41 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 37 IS - 3 N2 - 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. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/22930337/Malnutrition_may_worsen_the_prognosis_of_critically_ill_children_with_hyperglycemia_and_hypoglycemia_ L2 - https://doi.org/10.1177/0148607112458124 DB - PRIME DP - Unbound Medicine ER -