Abstract:

Objective To analyze the variation of blood glucose (BG) and relevant markers in critically ill children and its association with stress hyperglycemia． Methods Children aged under 14 years with critical disease in Guangzhou Women and Children's Medical Center PICU from January 2007 to April 2008 were enrolled. Within 24 h after entering PICU, recruited subjects were classified into hyperglycemia group and normoglycemia group according to BG greater than 6.1 mmol·L-1 or not. Additional healthy children attending regular physical examination in the same period were selected. Children in the two patient groups with BG<4.0 or >10.0 mmol·L-1 twice were excluded. BG, cortisol, growth hormones (GH), immune and cytokine levels and lipid profiles were measured dynamically on day 0 (the day admitted), day 3 and day 5 respectively. Results Ten children in normoglycemia group, 53 in hyperglycemia group and 15 in normal group were enrolled. ①In hyperglycemia group cortisol secretion peak was seen on day 0, and then declined. ②GH and insulin levels at 3 time points in hyperglycemia group were significantly higher than those in normoglycemia and control group. GH or IGF-1 levels in normoglycemia group did not differ significantly. ③The IGF-1 levels in hyperglycemia and normoglycemia groups kept increasing through day 0 to day 5, no significant difference between groups was observed. The IL-6 and triglyceride levels of hyperglycemia group on day 0 were significantly higher than those of other two groups, however, the high density lipoprotein cholesterol level was lower than that in normoglycemia group. ④Eight cases among hyperglycemia group died (8/53,15.1%). The BG, cortisol and insulin levels of the died cases were significantly higher than those of survival cases. Conclusions Elevated cortisol and insulin, accompanied abnormalities in cytokins and lipid profiles may be associated with the development of stress hyperglycemia in critically ill children, and may indicate poor prognosis.

Key words: Children, Critical illness, Cytokines, Hormone, Hyperglycemia, Lipid metabolism, Prognosis