Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 27 , ISSUE 10 ( October, 2023 ) > List of Articles

Original Article

Prognostic Value of Serum Glucose Level in Critically Ill Septic Patients on Admission to Pediatric Intensive Care Unit

Aya Osama Mohamed, Mohamed Abdallah Abd El-Megied, Yomna Ahmed Hosni

Keywords : Children, Hypoglycemia, Mortality, Sepsis

Citation Information : Mohamed AO, El-Megied MA, Hosni YA. Prognostic Value of Serum Glucose Level in Critically Ill Septic Patients on Admission to Pediatric Intensive Care Unit. Indian J Crit Care Med 2023; 27 (10):754-758.

DOI: 10.5005/jp-journals-10071-24546

License: CC BY-NC 4.0

Published Online: 29-09-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Sepsis is one of the major causes of admission to the pediatric intensive care unit (PICU), as well as a primary cause of poor outcomes. Glycemic variation may occur because of sepsis resulting in either hypoglycemia or hyperglycemia. Measuring the random blood glucose (RBG) level of patients presenting with sepsis in PICU is an easy way to assess their prognosis. Objectives: A prospective study was done from February 2023 to June 2023 to evaluate the relation between the outcome of pediatric septic patients and blood glucose level upon PICU admission. Patients and methods: One hundred three children diagnosed with sepsis underwent clinical assessment upon admission to the PICU and initial labs including blood glucose levels were done. Pediatric Sequential Organ Failure Assessment (pSOFA) was calculated for every patient. The outcome of sepsis including length of stay, review of body systems, and mortality was documented. Results: Hypoglycemic patients had the highest percentage of non-survivors (20.4%). They had a higher pSOFA score with a median of 11 (interquartile range—IQR 7–15), shorter PICU stay with a median of 2 (IQR 1–6) days, lower RBG with a median of 95 (45–120), a higher percentage of ventilation (55.1%), and a higher percentage of inotropic support (87.8%) with statistical significance with p-value (< 0.001, < 0.001, 0.001, < 0.001, 0.002), respectively. Conclusion: Critically ill patients with abnormal random blood sugar (RBS) had a higher possibility of non-survival particularly those with hypoglycemia. Accordingly, RBS measurement is a rapid and cheap method that could be used in any emergency and as an early indicator to detect outcome.

  1. de Souza DC, Gonçalves Martin J, Soares Lanziotti V, de Oliveira CF, Tonial C, de Carvalho WB, et al. The epidemiology of sepsis in paediatric intensive care units in Brazil (the Sepsis PREvalence Assessment Database in Pediatric population, SPREAD PED): An observational study. Lancet Child Adolesc Health 2021;5(12):873–881. DOI: 10.1016/S2352-4642(21)00286-8.
  2. Massaud-Ribeiro L, Silami PHNC, Lima-Setta F, Prata-Barbosa A. Pediatric sepsis research: Where are we and where are we going? Front Pediatr 2022;10:829119. DOI: 10.3389/fped.2022.829119.
  3. Ma P, Liu J, Shen F, Liao X, Xiu M, Zhao H, et al. Individualized resuscitation strategy for septic shock formalized by finite mixture modeling and dynamic treatment regimen. Crit Care 2021;25(1):243. DOI: 10.1186/s13054-021-03682-7.
  4. Güemes M, Rahman SA, Hussain K. What is a normal blood glucose? Arch Dis Child 2016;101(6):569–574. DOI: 10.1136/archdischild-2015-308336.
  5. Hartl WH, Jauch KW. Metabolic self-destruction in critically ill patients: Origins, mechanisms and therapeutic principles. Nutrition 2014;30(3):261–267. DOI: 10.1016/j.nut.2013.07.019.
  6. Wanek S, Wolf SE. Metabolic response to injury and role of anabolic hormones. Curr Opin Clin Nutr Metab Care 2007;10:272–277. DOI: 10.1097/MCO.0b013e3280f31b17.
  7. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet 2009;373(9677):1798–1807. DOI: 10.1016/S0140-6736(09)60553-5.
  8. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med 2006;355(18):1903–1911. DOI: 10.1056/NEJMcp060094.
  9. Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BA, et al. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med 2014;40(7):973–980. DOI: 10.1007/s00134-014-3287-7.
  10. Van Cromphaut SJ, Vanhorebeek I, Van den Berghe G. Glucose metabolism and insulin resistance in sepsis. Curr Pharm Des 2008;14:1887–1899. DOI: 10.2174/138161208784980563.
  11. Mitsuyama Y, Shimizu K, Komukai S, Hirayama A, Takegawa R, Ebihara T, et al. Sepsis-associated hypoglycemia on admission is associated with increased mortality in intensive care unit patients. Acute Med Surg 2022;9:e718. DOI: 10.1002/ams2.718.
  12. NICE-SUGAR Study Investigators, Finfer S, Liu B, Chittock DR, Norton R, Myburgh JA, et al. Hypoglycemia and risk of death in critically ill patients. N Engl J Med 2012;367(12):1108–1118. DOI: 10.1056/NEJMoa1204942.
  13. Khilnani P, Singhi S, Lodha R, Santhanam I, Sachdev A, Chugh K, et al. Pediatric sepsis guidelines: Summary for resource-limited countries. Indian J Crit Care Med 2010;14(1):41–52. DOI: 10.4103/0972-5229.63029.
  14. Chan YH. Biostatistics 102: Quantitative data – Parametric & non-parametric tests. Singapore Med J 2003;44(8):391–396. PMID: 14700417.
  15. Chan YH. Biostatistics 103: Qualitative data – Tests of independence. Singapore Med J 2003;44(10):498–503. PMID: 15024452.
  16. Chan YH. Biostatistics 104: Correlational analysis. Singapore Med J 2003;44(12):614–619. PMID: 14770254.
  17. de Farias E, Carvalho P, Júnior M, Dias L, Alves M, Alves S. Blood glucose and outcomes in critically ill children in Brazilian Amazon: An observational study. Res Soc Develop 2021;10(2):e54010212813. DOI: 10.33448/rsd-v10i2.12813.
  18. Hermanides J, Bosman RJ, Vriesendorp TM. Hypoglycemia is associated with intensive care unit mortality. Crit Care Med 2010;38:1430–1434. DOI: 10.1097/CCM.0b013e3181de562c.
  19. Bagshaw SM, Bellomo R, Jacka MJ, Egi M, Hart GK, George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care 2009;13(3):R91. DOI: 10.1186/cc7921.
  20. Kushimoto S, Abe T, Ogura H, Shiraishi A, Saitoh D, Fujishima S, et al. Impact of blood glucose abnormalities on outcomes and disease severity in patients with severe sepsis: An analysis from a multicenter, prospective survey of severe sepsis. PLoS One 2020;15:e0229919. DOI: 10.1371/journal.pone.0229919.
  21. Ssekitoleko R, Jacob ST, Banura P, Pinkerton R, Meya DB, Reynolds SJ, et al. Hypoglycemia at admission is associated with inhospital mortality in Ugandan patients with severe sepsis. Crit Care Med 2011;39:2271–2276. DOI: 10.1097/CCM.0b013e3182227bd2.
  22. Andersen SK, Gjedsted J, Christiansen C, Tonnesen E. The roles of insulin and hyperglycemia in sepsis pathogenesis. J Leukoc Biol 2004;75:413–421. DOI: 10.1189/jlb.0503195.
  23. Krinsley JS, Schultz MJ, Spronk PE, Harmsen RE, van Braam Houckgeest F, van der Sluijs JP, et al. Mild hypoglycemia is independently associated with increased mortality in the critically ill. Crit Care 2011;15(4):R173. DOI: 10.1186/cc10322.
  24. Day KM, Haub N, Betts H, Inwald DP. Hyperglycemia is associated with morbidity in critically ill children with meningococcal sepsis. Pediatr Crit Care Med 2008;9(6):636–640. DOI: 10.1097/PCC.0b013e31818d350b.
  25. Blesa Malpica AL, Cubells Romeral M, Morales Sorribas E, Tejero Redondo A, Martínez Sagasti F, Martín Benítez JC, et al. La glucemia de las primeras horas no es un factor pronóstico de mortalidad en pacientes críticos. Nutr Hosp 2011;26(3):622–635. DOI: 10.1590/S0212-16112011000300028.
  26. Freire AX, Bridges L, Umpierrez GE, Kuhl D, Kitabchi AE. Admission hyperglycemia and other risk factors as predictors of hospital mortality in a medical ICU population. Chest 2005;128(5):3109–3116. DOI: 10.1378/chest.128.5.3109.
  27. Larrondo Muguercia HM, Jiménez Paneque R, Torres Hernández MR, Roque Guerra A, León Pérez D. Valoración de la glucemia sérica como marcador pronóstico en el paciente séptico crítico. Rev Cubana Endocrinol 2010;21(3):269–278.
  28. Toro-Polo LM, Ortiz-Lozada RY, Chang-Grozo SL, Hernandez AV, Escalante-Kanashiro R, Solari-Zerpa L. Glycemia upon admission and mortality in a pediatric intensive care unit. Glicemia na admissão e mortalidade em unidade de terapia intensiva pediátrica. Rev Bras Ter Intensiva 2018;30(4):471–478. DOI: 10.5935/0103-507X.20180068.
  29. Singer M, Deutschman CS, Seymour C, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). J Am Med Assoc 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  30. Van Vught LA, Wiewel MA, Klein Klouwenberg PMC, Hoogendijk AJ, Scicluna BP, Ong DSY, et al. Admission hyperglycemia in critically ill sepsis patients: Association with outcome and host response. Crit Care Med 2016;44(7):1338–1346. DOI: 10.1097/CCM.0000000000001650.
  31. Wang W, Chen W, Liu Y, Li L, Li S, Tan J, et al. Blood glucose levels and mortality in patients with sepsis: Dose–response analysis of observational studies. J Intensive Care Med 2021;36(2):182–190. DOI: 10.1177/08850666198893.
  32. Kyle UG, Coss Bu JA, Kennedy CE, Jefferson LS. Organ dysfunction is associated with hyperglycemia in critically ill children. Intensive Care Med 2010;36(2):312–320. DOI: 10.1007/s00134-009-1703-1.
  33. Tirkey SS, Verma RK. Association of hyperglycaemia with outcome in critically ill children in Central India – A prospective study. J Evid Based Med Healthc 2021;8(13):811–815. DOI: 10.18410/jebmh/2021/159.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.