Admission dysglycaemia as a prognostic factor for adverse in-hospital clinical outcomes in children at the Mother and Child Centre of the Chantal Biya Foundation

Nabengu Kenneth Okenye (nabengukenneth90@yahoo.com)
PEDIATRICS, THE UNIVERSITY OF YAOUNDE I
June, 2016
 

Abstract

Admission dysglycaemia in children is a very frequent occurrence in paediatric emergency units. The prevalence of dysglycamia in critically ill children stands at 31.75% in Ghana(1). Stress hyperglycaemia is more frequent than hypoglycaemia. An abnormal blood sugar concentration is not related to any particular diagnosis. Admission dysglycaemia has been shown to be associated with many clinical conditions among which are severe malaria, severe acute malnutrition, sepsis, pneumonia and shock. Admission dysglycaemia is generally related to the degree of severity of the underlying disease and hence can serve as an important prognostic marker. Dysglycaemia on admission in severely sick children is associated with adverse clinical outcomes (longer lengths of hospital stay, high in-hospital mortality and high risk to be transferred to the intensive care unit). Little is known about this subject in Cameroon.
Objectives: The main aim of this study was to evaluate the relationship between admission dysglycaemia and adverse in-hospital clinical outcomes in children admitted to the hospital through the paediatric emergency unit.
Materials and methods: We carried out a prospective cohort study from September 2015 to March 2016 at the Mother and Child Centre (MCC) of the Chantal Biya Foundation (CBF). Children with a severe acute medical condition, aged between 28 days and 16 years were our target population. Authorisations to carry out this study were obtained from the ethics committee of the Faculty of Medicine and Biomedical Sciences of the University of Yaounde I, the administration of the MCC of the CBF and from the parents of the children. Data collection was done in two phases: on admission, the blood sugar level was determined and clinical data obtained, and on discharge, the hospitalisation files were checked for final diagnosis, date of discharge or death and transfer to the intensive care unit (ICU). Statistical analysis was done with the aid of the statistical package for social science (SPSS) software version 20.0. Pearson’s chi square test and Fisher’s exact test were used to compare categorical variables while Kruskal-Wallis test and Mann Whitney U were used to compare numerical variables. Results were expressed in medians, frequencies, percentages, relative risks and P values. P value < 0.05 was statistically significant.
Results: Of the 203 children sampled, 108 (53.2%) were boys and 95 (46.8%) girls. The median age was 30 months (range: 184 months, IQR: 14-68 months). Children less than 5 years made up 70.4%. The prevalence of hypoglycaemia on admission was 3.45% and stress hyperglycaemia on admission 31.53%. Unconsciousness and respiratory distress were the most frequent symptoms significantly associated with dysglycaemia (P<0.05). Severe malaria, severe acute malnutrition and sickle cell disease emergencies were the diseases mostly associated to dysglycaemia. Children with hypoglycaemia on admission stayed shorter in hospital compared to those with no hypoglycaemia. Children with dysglycaemia were 7.1 times more likely to be transferred to the ICU compared to those with a normal glycaemia (p<0.01). Children with dysglycaemia were also 7.4 times more likely to die compared to those with a normal glycaemia (p<0.01). Dysglycaemia was associated with death within the first 24 hours of admission.
Conclusion and recommendations: Admission dysglycaemia is a frequent occurrence in children with a severe acute medical condition at the Mother and Child Centre of the Chantal Biya Foundation with a prevalence of 34.9%. Severe malaria, severe sepsis, severe acute malnutrition, sickle cell crisis and severe gastroenteritis were the most frequent diseases associated with dysglycaemia while unconsciousness and respiratory distress were the presenting symptoms associated with dysglycaemia. Children with admission dysglycaemia had a higher risk of dying and to be transferred to the intensive care unit. Children with no hypoglycaemia on admission stayed longer in the hospital compared to those with hypoglycaemia. We recommend clinicians to always run a glycaemia before deciding whether to give glucose infusion to all patients and to treat more aggressively patients with dysglycaemia. The ministry of public health should include in the integrated management of childhood diseases protocol the systematic measurement of glycaemia in all critically ill children.


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