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The association between stress hyperglycemia and poor outcome in critically ill children is modulated by hyperlactatemia

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机构： [1]1Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China [2]Department of Pediatrics, Women and Children’s Hospital of Chongqing Medical University, Chongqing Health Center for Women and Children, Chongqing, China [3]Department of Pediatric Critical Care, Chengdu Women and Children’s Central Hospital, Chengdu, Sichuan, China [4]Department of Pediatric Intensive Medicine, Chongqing University Three Gorges Hospital, Wanzhou, Chongqing, China [5]Department of Pediatric Critical Care, The First People’s Hospital of Zunyi, Zunyi, Guizhou, China [6]Department of Pediatric Critical Care, Kunming Children’s Hospital, Kunming, Yunnan, China

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关键词： critically ill children hyperlactatemia stress hyperglycemia outcome

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The available evidence on tight glycemic control is conflicting, while the interaction between glucose and lactate in critically ill children remains unclear.To explore the potential role of hyperlactatemia (HL) in modulating the relationship between stress hyperglycemia (SHG) and poor outcomes, aiming to establish tailored glucose targets in critically ill children.This was a secondary analysis of a prospective observational cohort study conducted in five Pediatric Intensive Care Units (PICU) in southwestern China (ChiCTR2000030846). The interaction effect between glucose and lactate metrics concerning outcomes and subsequent subgroup regression analysis was conducted. SHG was defined as glucose > 150 mg/dL(8.3mmol/L) and HL as lactate > 2 mmol/L.A cohort of 433 pediatric patients with 4885 arterial blood gas measurements were finally enrolled. 90 (20.8%) cases died within 28 days of PICU admission. Significant interaction effects between SHG and HL on outcomes were observed (p < 0.05). In the non-HL group, SHG was not an independent predictor of 28-day mortality (p = 0.656) and was not correlated with either 28-day ventilator-free days (p = 0.916) or 28-day ICU-free days (p = 0.914). In contrast, in the HL group, SHG was independently associated with 28-day mortality (OR 3.55, 95% CI 1.62~7.80, p = 0.002) and correlated with a reduction of 5.04 28-day ventilator-free days (p = 0.003) and 4.10 28-day ICU-free days (p = 0.004).HL potentially modulates the correlation between SHG and poor outcomes in pediatric critically ill patients. Combined SHG and HL are associated with poor outcomes, whereas SHG without HL is not.Copyright © 2025 Liu, Dong, Li, Zhang, Chen, Jiang, Duan, Xiong, Huang, Zou, Liu, Fu and Yu.

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大类 | 3 区医学

小类 | 3 区内分泌学与代谢

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第一作者机构： [1]1Department of Critical Care Medicine, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China

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The association between stress hyperglycemia and poor outcome in critically ill children is modulated by hyperlactatemia

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