Browse > Article
http://dx.doi.org/10.3345/kjp.2008.51.5.474

Early stress hyperglycemia as independent predictor of increased mortality in preterm infants  

Wee, Young Sun (Department of Pediatrics, College of Medicine, Pochon CHA University)
Ahn, Gae Hyun (Department of Pediatrics, College of Medicine, Pochon CHA University)
Yoo, Eun Gyong (Department of Pediatrics, College of Medicine, Pochon CHA University)
Lim, In Sook (Department of Pediatrics, College of Medicine, Pochon CHA University)
Lee, Kyu Hyung (Department of Pediatrics, College of Medicine, Pochon CHA University)
Publication Information
Clinical and Experimental Pediatrics / v.51, no.5, 2008 , pp. 474-480 More about this Journal
Abstract
Purpose : Stress hyperglycemia is common in critically ill adult patients. It is known as a predictor of increased mortality, and intensive insulin therapy has been shown to improve the prognosis in such patients. We have investigated the relationship between early stress hyperglycemia and clinical outcomes in preterm infants. Methods : In this study, 141 preterm infants with a gestational age of less than 30 weeks were enrolled. The hyperglycemic group was defined as that having maximum glucose of more than 150 mg/dL (n=61) during the first 48 h of life, and the non-hyperglycemic group was defined as that having maximum glucose of less than 150 mg/dL (n=80). Perinatal history, severity of illness using the Clinical Risk Index for Babies (CRIB) score, clinical outcomes, and mortality of the two groups were compared. Results : There was no significant difference in the gestational age between the two groups, but the birth weight (P<0.001) was significantly lower, and the CRIB score (P<0.001) was significantly higher in the hyperglycemic group. Disseminated intravascular coagulation (P<0.001) and clinically suspected sepsis (P=0.046) were more common in the hyperglycemic group. Mortality was markedly higher in the hyperglycemic group (11.3% vs. 41.0%, P<0.001). On performing a stepwise multiple logistic regression analysis, hyperglycemia (OR 3.787; 95% CI 1.324 to 10.829), the CRIB score (OR 1.252; 95% CI 1.047 to 1.496) and birth weight (OR 0.997; 95% CI 0.994 to 1.000) was independently associated with higher mortality. Conclusion : Stress hyperglycemia within the first 48 h of life is independently related to increased morbidity and mortality in preterm infants.
Keywords
Hyperglycemia; Preterm; Mortality; CRIB;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Whitcomb BW, Pradhan EK, Pittas AG, Roghrnann MC, Perencevich EN. Irnpact of admission hyperglycemia on hospital mortality in various intensive care unit populations. Crit Care Med 2005:33:2772-7.   DOI   ScienceOn
2 Faustino EV, Apkon M. Persistent hyperglycemia in critically ill children. J Pediatr 2005:146:30-4.   DOI   ScienceOn
3 Hays SP, Smith EO, Sunehag AL. Hyperglycemia is a risk factor for early death and morbidity in extremely low birth-weight infants. Pediatrics 2006;118:1811-8.   DOI   ScienceOn
4 Srinivasan V, Spinella PC, Drott HR, Roth CL, Helfaer MA, Nadkami V. Association of timing, duration, and intensity of hyperglycemia with intensive care unit mortality in critically ill children. Pediatr Crit Care Med 2004:5:329-36.   DOI   ScienceOn
5 Kao LS, Morris BH, Lally KP, Stewart CD, Husehy V, Kennedy KA. Hyperglycemia and morbidity and mortality in extremely low birth weight infants. J Perinatol 2006;26: 730-6.   DOI   ScienceOn
6 The CRlB (clinical risk index for babies) score: A tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. the international neonatal network. Lancet 1993;342:193-8.   DOI   ScienceOn
7 Morris BH, Miller-Loncar CL, Landry SH, Smith KE, Swank PR, Denson SE. Feeding, medical factors, and developmental outcome in premature infants. Clin Pediatr (Phila) 1999;38: 451-7.   DOI
8 Esposito K, Nappo F, Martella R, Giugliano G, Giugliano F, Ciotola M, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: Role of oxidative stress. Circulation 2002;106:2067-72.   DOI   ScienceOn
9 Garg R, Agthe AG, Donohue PK, Lehmann CU, Hypergly-cemia and retinopathy of prematurity in very low birth weight infants, J Perinatol 2003;23:186-94,   DOI   ScienceOn
10 Orford NR Intensive insulin therapy in septic shock. Crit Care Resusc 2006;8:230-4.
11 Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: A clinical and laboratory challenge. Clin Chem 2004:56:279-87.
12 Finney SJ, Zekveld C, Elia A, Evans TW, Glucose control and mortality in critically ill patients, JAMA 2003;290:2041-7.   DOI   ScienceOn
13 Wasmuth HE, Kunz D, Graf I, Stanzel S, Purucker EA, Koch A, et al. Hyperglycemia at admission to the intensive care unit is associated with elevated serum concentrations of interleukin-f and reduced ex vivo secretion of tumor necrosis factor-alpha. Crit Care Med 2004;32:1109-14.   DOI   ScienceOn
14 Pharo TN, Warren AJ, Phan HR, Mohtor F, Greenhalgh DG, Palmieri TL. Irnpact of tight glycemic control in severely hurned children. J Trauma 2005:59:1148-54.
15 Hansen TK, Thiel S, Wouters PI, Christiansen JS, Van den Berghe G. Intensive insulin therapy exerts antiinflammatory effects in critically ill patients and counteracts the adverse effect of low rnannose-binding lectin levels. J Clin Endocrinol Metab 2003:88:1082-8.   DOI
16 Farrag HM, Cowett RM, Glucose homeostasis in the micropremie. Clin Perinatol 2000;27:1-22,   DOI
17 Urnpierrez GE, Isaacs SD, Bazargan N, You X, Thaler LM, Kitabchi AE. Hyperglycemia: An independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002:37:978-82.
18 Silveira Rde C, Schlabendorff M, Procianoy RS. Predictive value of SNAP and SNAP- PE for neonatal mortality. J Pediatr (Rio J) 2001.77:455-66.   DOI
19 Krinsley JS. Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc 2003;78:1471-8.
20 Valerio G, Franzese A, Carlin E, Pecile P, Perini R, Tenore A. High prevalence of stress hyperg lycaernia in children with febrile seizures and traurnatic injuries, Acta Paediatr 2001;90:618-22.   DOI
21 Ertl T, Gyarrnati J, Gaal V, Szabo I. Relationship between hyperglycemia and retinopathy of prematurity in very low birth weight infants. Biol Neonate 2006;89:56-9.   DOI   ScienceOn
22 Bhisitkul DM, Morrow AL, Vinik AI, Shults I, Layland JC, Rohn R. Prevalence of stress hyperglycemia among patients attending a pediatric emergency department. J Pediatr 1994; 124:547-51.   DOI   ScienceOn
23 McCowen KC, Malhotra A, Bistrian BR. Stress-induced hyperglycemia. Crit Care Clin 2001;17:107-24.   DOI
24 Capes SE, Hunt D, Malmberg K, Gerstein He. Stress hyperglycaernia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 2000;355:773-8   DOI   ScienceOn
25 Pati NK, Maheshwari R, Pati NK, Salhan RN. Transient neonatal hyperglycemia. Indian Pediatr 2001;38:898-901.
26 Hey E. Hyperglycaernia and the very preterm baby. Semin Fetal Neonatal Med 2005:10:377-87.   DOI   ScienceOn
27 Branco RG, Garcia PC, Piva JP, Casartelli CH, Seibel V, Tasker RC, Glucose level and risk of mortality in pediatric septic shock. Pediatr Crit Care Med 2005;6:470-2.   DOI   ScienceOn
28 Mizock BA Alterations in fuel metabolism in critical illness: Hyperglycaernia. Best Pract Res Clin Endocrinol Metab 2001 15:533-51.   DOI   ScienceOn
29 Van den Berghe G, Wouters PJ, Bouillon R, Weekers F, Verwaest C, Schetz M, et al. Outcome benefit of intensive insulin therapy in the critically ill: Insulin dose versus glycemic control. Crit Care Med 2003;31:359-66.   DOI   ScienceOn
30 Gore DC, Chinkes D, Heggers J, Herndon DN, Wolf SE, Desai M, Association of hyperglycemia with increased mortality after severe burn injury, J Trauma 2001;51:540-4.   DOI
31 Langouche L, Vanhorebeek I, Vlasselaers D, Vander Perre S, Wouters PJ, Skogstrand K, et al. Intensive insulin therapy protects the endothelium of critically ill patients. J Clin Invest 2005:115:2277-86.   DOI   ScienceOn
32 Dandona P, Mohanty P, Chaudhuri A, Garg R, Aljada A. Insulin infusion in acute illness. J Clin Invest 2005;115: 2069-72.   DOI   ScienceOn
33 Hall NI, Peters M, Eaton S, Pierro A Hyperglycemia is associated with increased morbidity and mortality rates in neonates with necrotizing enterocolitis. J Pediatr Surg 2004; 39:898-901.   DOI   ScienceOn