Association of dysglycemia with mortality in children receiving parenteral nutrition in pediatric intensive care unit

Özet

One of the most important complications of parenteral nutrition (PN) is ahigh incidence of hyperglycemia. The aim of this study was to assess theeffect of parenteral nutrition dysglycemia on clinical outcomes among criticallyill children in pediatric intensive care unit (PICU). Charts of 201 critically illchildren admitted in PICU during 2012-2015 were reviewed retrospectively.We included patients who were <6 years of age and had received at least60% of total energy from PN for a minimum of 5 days in PICU. Theexclusion criteria were patients with diagnosis of diabetes mellitus, primaryhypoglycemia, inborn errors of metabolism and patients who received dialyses.We defined hyperglycemia as blood glucose ≥150 mg/dl, and hypoglycemia asblood glucose ≤60 mg/dl. Based on blood glucose, patients were divided intofour groups: “only hyperglycemia group” (having at least one hyperglycemiaepisode), “only hypoglycemia group” (having at least one hypoglycemiaepisode), “glucose variability” (having both hypoglycemia and hyperglycemiaepisodes), and “normoglycemia” (all glucose measurements were in normalrange). Hyperglycemia and hypoglycemia occurred in 52.8% and 24.9% of allchildren, respectively; glucose variability occurred in 13.9% of all children.Multiple logistic regression analysis showed that glucose variability (OR: 3.1;95% CI: 1.13-8.43) and hyperglycemia (OR: 2.14; 95% CI: 1.1-4.57) wereassociated with mortality independently. In “only hypoglycemia” group (N=22)there were only three deaths. There were no significant differences in thequantities of macronutrients prescribed via parenteral nutrition among thefour blood glucose groups. Results of this study showed that hyperglycemiaand glucose variability are strong predictors of mortality in pediatrics receivingparenteral nutrition.