The association of hypoglycemia with outcome of critically ill children in relation to nutritional and blood glucose control strategies

Gunst, Jan; De Bruyn, Astrid; Jacobs, An; Langouche, Lies; Derese, Inge; Dulfer, Karolijn; Güiza, Fabian; Garcia Guerra, Gonzalo; Wouters, Pieter J.; Joosten, Koen F.; Verbruggen, Sascha C.; Vanhorebeek, Ilse; Van den Berghe, Greet

doi:10.1186/s13054-023-04514-6

Critical Care

Table 3 Models additionally adjusted for glucose metrics, PICU-stay duration and for interaction with center and randomization

From: The association of hypoglycemia with outcome of critically ill children in relation to nutritional and blood glucose control strategies

Neurodevelopmental outcome after 4 years¹	Working memory		Planning and organization		Metacognition
Neurodevelopmental outcome after 4 years¹	β-Estimate (95% CI)	P	β-Estimate (95% CI)	P	β-Estimate (95% CI)	P
Model adjusted for baseline risk factors, glucose metrics and length of stay in PICU (model 1)
Hypoglycemia	1.98 (0.39 to 3.57)	0.015	1.73 (0.21 to 3.24)	0.026	1.60 (0.01 to 3.19)	0.049
After additional adjustment for baseline NSE/S100B
Hypoglycemia	2.13 (0.43 to 3.83)	0.014	1.87 (0.24 to 3.51)	0.025	1.74 (0.04 to 3.45)	0.045
Model 1, additionally adjusted for the interaction of hypoglycemia with center
Hypoglycemia	3.04 (0.78 to 5.31)	0.009	2.21 (0.05 to 4.38)	0.045	2.62 (0.36 to 4.88)	0.023
Hypoglycemia*center (Leuven)	− 1.49 (− 3.74 to 0.77)	0.20	− 0.68 (− 2.83 to 1.47)	0.54	− 1.42 (− 3.67 to 0.83)	0.21
After additional adjustment for baseline NSE/S100B
Hypoglycemia	3.99 (1.19 to 6.79)	0.005	3.19 (0.49 to 5.89)	0.021	3.61 (0.80 to 6.42)	0.012
Hypoglycemia*center (Leuven)	− 2.30 (− 5.04 to 0.45)	0.10	− 1.62 (− 4.27 to 1.02)	0.23	− 2.30 (− 5.06 to 0.45)	0.10
Model 1, additionally adjusted for the interaction of hypoglycemia with randomization
Hypoglycemia	2.06 (0.38 to 3.74)	0.016	1.90 (0.30 to 3.50)	0.020	1.82 (0.15 to 3.50)	0.033
Hypoglycemia*randomization (Late-PN)	− 0.25 (− 1.83 to 1.33)	0.75	− 0.53 (− 2.02 to 0.97)	0.49	− 0.68 (− 2.25 to 0.89)	0.40
After additional adjustment for baseline NSE/S100B
Hypoglycemia	2.56 (0.69 to 4.42)	0.007	2.38 (0.59 to 4.18)	0.009	2.40 (0.53 to 4.27)	0.012
Hypoglycemia*randomization (Late-PN)	− 0.97 (− 2.69 to 0.76)	0.27	− 1.14 (− 2.80 to 0.52)	0.18	− 1.47 (− 3.20 to 0.26)	0.096

PICU: pediatric intensive care unit
Baseline risk factors include age, sex, treatment center, randomization group, pediatric index of mortality (PIM3 score) at time of admission, Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) risk level at time of admission, diagnostic category, history of malignancy, predefined syndrome, race, geographic origin, language, parental educational level, parental occupational level, parental smoking before admission, left-hand preference, and (where applicable, as indicated in the table) upon-admission concentrations of NSE and S100B. As no patient had diabetes, diabetes was not included in the multivariable models. All models were adjusted for glucose metrics in PICU (mean morning blood glucose and SD of all glucose measurements in PICU) and for length of stay in PICU
¹Higher scores reflect worse performance

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