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Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study

BACKGROUND: To study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care. METHODS: Observational study in twenty-nine critically ill children with severe hyperglycemia defined as 2 blood glucose mea...

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Autores principales: Ballestero, Yolanda, López-Herce, Jesús, González, Rafael, Solana, Maria José, del Castillo, Jimena, Urbano, Javier, Botran, Marta, García, Ana, López, Nieves, Bellón, Jose María
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2014
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995587/
https://www.ncbi.nlm.nih.gov/pubmed/24628829
http://dx.doi.org/10.1186/1472-6823-14-25
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author Ballestero, Yolanda
López-Herce, Jesús
González, Rafael
Solana, Maria José
del Castillo, Jimena
Urbano, Javier
Botran, Marta
García, Ana
López, Nieves
Bellón, Jose María
author_facet Ballestero, Yolanda
López-Herce, Jesús
González, Rafael
Solana, Maria José
del Castillo, Jimena
Urbano, Javier
Botran, Marta
García, Ana
López, Nieves
Bellón, Jose María
author_sort Ballestero, Yolanda
collection PubMed
description BACKGROUND: To study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care. METHODS: Observational study in twenty-nine critically ill children with severe hyperglycemia defined as 2 blood glucose measurements greater than 180 mg/dL. Severity of illness was assessed using pediatric index of mortality (PIM2), pediatric risk of mortality (PRISM) score, and pediatric logistic organ dysfunction (PELOD) scales. Blood glucose, glycosuria, insulin, C-peptide, cortisol, corticotropin, insulinlike growth factor-1, growth hormone, thyrotropin, thyroxine, and treatment with insulin were recorded. β-cell function and insulin sensitivity and resistance were determined on the basis of the homeostatic model assessment (HOMA), using blood glucose and C-peptide levels. RESULTS: The initial blood glucose level was 249 mg/dL and fell gradually to 125 mg/dL at 72 hours. Initial β-cell function (49.2%) and insulin sensitivity (13.2%) were low. At the time of diagnosis of hyperglycemia, 50% of the patients presented insulin resistance and β-cell dysfunction, 46% presented isolated insulin resistance, and 4% isolated β-cell dysfunction. β-cell function improved rapidly but insulin resistance persisted. Initial glycemia did not correlate with any other factor, and there was no relationship between glycemia and mortality. Patients who died had higher cortisol and growth hormone levels at diagnosis. Length of stay was correlated by univariate analysis, but not by multivariate analysis, with C-peptide and glycemic control at 24 hours, insulin resistance, and severity of illness scores. CONCLUSIONS: Critically ill children with severe hyperglycemia initially present decreased β-cell function and insulin sensitivity. Nonsurvivors had higher cortisol and growth hormone levels and developed hyperglycemia later than survivors.
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spelling pubmed-39955872014-04-23 Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study Ballestero, Yolanda López-Herce, Jesús González, Rafael Solana, Maria José del Castillo, Jimena Urbano, Javier Botran, Marta García, Ana López, Nieves Bellón, Jose María BMC Endocr Disord Research Article BACKGROUND: To study hormonal changes associated with severe hyperglycemia in critically ill children and the relationship with prognosis and length of stay in intensive care. METHODS: Observational study in twenty-nine critically ill children with severe hyperglycemia defined as 2 blood glucose measurements greater than 180 mg/dL. Severity of illness was assessed using pediatric index of mortality (PIM2), pediatric risk of mortality (PRISM) score, and pediatric logistic organ dysfunction (PELOD) scales. Blood glucose, glycosuria, insulin, C-peptide, cortisol, corticotropin, insulinlike growth factor-1, growth hormone, thyrotropin, thyroxine, and treatment with insulin were recorded. β-cell function and insulin sensitivity and resistance were determined on the basis of the homeostatic model assessment (HOMA), using blood glucose and C-peptide levels. RESULTS: The initial blood glucose level was 249 mg/dL and fell gradually to 125 mg/dL at 72 hours. Initial β-cell function (49.2%) and insulin sensitivity (13.2%) were low. At the time of diagnosis of hyperglycemia, 50% of the patients presented insulin resistance and β-cell dysfunction, 46% presented isolated insulin resistance, and 4% isolated β-cell dysfunction. β-cell function improved rapidly but insulin resistance persisted. Initial glycemia did not correlate with any other factor, and there was no relationship between glycemia and mortality. Patients who died had higher cortisol and growth hormone levels at diagnosis. Length of stay was correlated by univariate analysis, but not by multivariate analysis, with C-peptide and glycemic control at 24 hours, insulin resistance, and severity of illness scores. CONCLUSIONS: Critically ill children with severe hyperglycemia initially present decreased β-cell function and insulin sensitivity. Nonsurvivors had higher cortisol and growth hormone levels and developed hyperglycemia later than survivors. BioMed Central 2014-03-14 /pmc/articles/PMC3995587/ /pubmed/24628829 http://dx.doi.org/10.1186/1472-6823-14-25 Text en Copyright © 2014 Ballestero et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Ballestero, Yolanda
López-Herce, Jesús
González, Rafael
Solana, Maria José
del Castillo, Jimena
Urbano, Javier
Botran, Marta
García, Ana
López, Nieves
Bellón, Jose María
Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title_full Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title_fullStr Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title_full_unstemmed Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title_short Relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
title_sort relationship between hyperglycemia, hormone disturbances, and clinical evolution in severely hyperglycemic post surgery critically ill children: an observational study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3995587/
https://www.ncbi.nlm.nih.gov/pubmed/24628829
http://dx.doi.org/10.1186/1472-6823-14-25
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