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Submitted on March 8, 2006
Accepted on May 23, 2006
Department of Pediatrics, Research Institute Nutrim, University Hospital Maastricht, Maastricht, The Netherlands; Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Surgery, Research Institute Nutrim, Maastricht University, Maastricht, The Netherlands
* To whom correspondence should be addressed. E-mail: dvwa{at}paed.azm.nl.
CONTEXT: Hyperglycemia and insulin resistance are common findings in critically ill patients and associated with increased morbidity and mortality. OBJECTIVES: To investigate the hyperglycemic response to critical illness in children. DESIGN: Observational cohort study. SETTING: University affiliated pediatric intensive care unit. PATIENTS: Six children with meningococcal sepsis (MS), ten children with meningococcal septic shock (MSS). MAIN OUTCOME MEASURES: Differences in blood glucose levels (measured during 72 h after admission) and differences in plasma levels of glucoregulatory hormones (insulin, GH, IGF-1, cortisol, glucagons, leptin), soluble cytokine receptors (sTNF-R55, R75, sIL-1-R2) and IL-6 on day 3 between MS and MSS patients. RESULTS: Blood glucose levels on day 2 and 3 were higher in MSS patients than in MS patients (7.5 (3.9-13.0) vs. 5.1 (4.0-6.0) and 6.5 (4.0-9.9) vs. 5.5 (4.8-6.8) mmol/l, both P < 0.05). Maximum blood glucose values recorded in individual patients were higher in MSS patients (9.3 (6.5-13) vs. 7.2 (6.2-9.9, P < 0.05) and correlated with severity of illness (r = 0.833, P < 0.001). Insulin levels in MSS patients were significantly lower (7.2 vs. 19.0 mU/l, P < 0.001) compatible with insufficient insulin response to hyperglycemia while MS patients showed insulin resistance. Insulin levels correlated inversely with levels of sTNF-R55 and R75 (r = -0.814 and -0.878, both P < 0.001) suggesting suppression of the pro-inflammatory response on insulin secretion. CONCLUSION: Hyperglycemia associated with hypoinsulinemia rather than insulin resistance may be the normal pathophysiological response in acute meningococcal septic shock in children. Our study emphasizes that application of intensive insulin therapy in critically ill children demands further investigation.
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