Abstract
Objectives: Patterns and outcomes of multiple organ dysfunction syndrome are unknown in critically ill children with hyperglycemia. We aimed to determine whether tight glycemic control to a lower vs. higher range influenced timing, duration, or resolution of multiple organ dysfunction syndrome as well as characterize the clinical outcomes of subgroups of multiple organ dysfunction syndrome in children enrolled in the Heart And Lung Failure-Pediatric INsulin Titration trial. Design: Planned secondary analysis of the multicenter Heart And Lung Failure-Pediatric INsulin Titration trial. Setting: Thirty-five PICUs. Patients: Critically ill children with hyperglycemia who received the Heart And Lung Failure-Pediatric INsulin Titration protocol from 2012 to 2016. Interventions: Randomization to a lower versus higher glucose target group. Measurements and Main Results: Of 698 patients analyzed, 48 (7%) never developed multiple organ dysfunction syndrome, 549 (79%) had multiple organ dysfunction syndrome without progression, 32 (5%) developed new multiple organ dysfunction syndrome, and 69 (10%) developed progressive multiple organ dysfunction syndrome. Of those whose multiple organ dysfunction syndrome resolved, 192 (34%) experienced recurrent multiple organ dysfunction syndrome. There were no significant differences in the proportion of multiple organ dysfunction syndrome subgroups between Heart And Lung Failure-Pediatric INsulin Titration glucose target groups. However, patients with new or progressive multiple organ dys function syndrome had fewer ICU-free days through day 28 than those without new or progressive multiple organ dysfunction syndrome, and progressive multiple organ dysfunction syndrome patients had fewer ICU-free days than those with new multiple organ dysfunction syndrome: Median 25.1 days for never multiple organ dysfunction syndrome, 20.2 days for multiple organ dysfunction syndrome without progression, 18.6 days for new multiple organ dysfunction syndrome, and 0 days for progressive multiple organ dysfunction syndrome (all comparisons p < 0.001). Patients with recurrent multiple organ dysfunction syndrome experienced fewer ICU-free days than those without recurrence (median, 11.2 vs 22.8 d; p < 0.001). Conclusions: Tight glycemic control target range was not associated with differences in the proportion of new, progressive, or recurrent multiple organ dysfunction syndrome. New or progressive multiple organ dysfunction syndrome was associated with poor clinical outcomes, and progressive multiple organ dysfunction syndrome was associated with worse outcomes than new multiple organ dysfunction syndrome. In future studies, new multiple organ dysfunction syndrome and progressive multiple organ dysfunction syndrome may need to be considered separately, as they represent distinct subgroups with different, potentially modifiable risk factors. Patients with recurrent multiple organ dysfunction syndrome represent a newly characterized, high-risk group which warrants attention in future research.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1147-1156 |
| Number of pages | 10 |
| Journal | Pediatric Critical Care Medicine |
| Volume | 20 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 1 2019 |
Funding
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL. 2Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL. 3Department of Cardiology, Boston Children’s Hospital, Boston, MA. 4Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA. 5Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 6Department of Pediatrics, Harvard Medical School, Boston, MA. 7Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA. 8Division of Medical Critical Care, Department of Pediatrics, Boston Children’s Hospital, Boston, MA. Members of the Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators are listed in the Appendix (Supplemental Digital Content 1, http://links.lww.com/PCC/B101). Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal). Supported, in part, by grants from the National Heart, Lung, and Blood Institute (U01 HL107681 and U01 HL108028). Drs. Marsillio’s, Wypij’s, and Ms. Asaro’s institutions received funding from National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute. Drs. Marsillio, Srinivasan, Wypij, Agus, Nadkarni, and Ms. Asaro received support for article research from the NIH. Dr. Sorce’s institution received funding from the NIH. This work was completed at Ann & Robert H. Lurie Children’s Hospital of Chicago, Boston Children’s Hospital, and Children’s Hospital of Philadelphia based on data from the multicenter Heart And Lung Failure-Pediatric INsulin Titration trial. For information regarding this article, E-mail: [email protected]
Keywords
- hyperglycemia
- mortality
- multiple organ dysfunction syndrome
- outcome
- pediatric intensive care unit
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
- Pediatrics, Perinatology, and Child Health