Prevalence, outcome and factors associated with dysglycemia among critically ill children presenting to Fort Portal Regional Referral Hospital

Abstract

Background: Dysglycemia is metabolic disorder characterized by hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar). In remote and resource limited settings, alterations in blood glucose levels in sick children often go undetected because of the lack of available tools for prompt and routine blood glucose measurements. In Uganda data on dysglycemia among critically ill children is scarce. Objective: The objective of this study was to determine the prevalence, outcome and factors associated with dysglycemia among critically ill children aged one month to 12 years presenting to Fort Portal Regional Referral Hospital. Methods: A descriptive cross-sectional study design was employed to evaluate the prevalence and factors associated, with additional assessement of the immediate outcome among critically ill children with dysglycemia. This study was conducted among critically ill children aged one month to 12 years presenting to Fort Portal Regional Referral Hospital between February 2020 to April 2020. The Research Assistants triaged critically ill children at the Out-Patient Department for the emergency signs. Verbal consent was obtained from the parents/guardians of critically ill children on arrival whereas written informed consent was ascertained after stabilization of study participants while on the paediatric ward. A random blood glucose was taken as soon as critically ill children were admitted at the paediatric ward. Those found to be hypoglycemic were given Dextrose 10% and those found with hyperglycemia had no intervention. Data was recorded using structured pre-coded case record forms and was thereafter entered into an electronic database using Epidata version 3.1 software package. STATA version 15 was used for analysis. Multivariable logistic regression model was used to obtain factors that were independently associated with dysglycemia at a p<0.05 and 95% confidence interval. A p-value < 0.05 was considered statistically significant. Results: Three hundred and eighty-four critically ill children were enrolled into this study with a male to female ratio of 1.3:1. The median age (IQR) was 29.5 months (12 to 63). Dysglycemia was present in 83(21.7%) of the study participants. Of those with dysglycemia, 65(78.3%) had hypoglycemia and 18(21.7%) had hyperglycemia. The proportion of dysglycemia at 24 hours was 2/ 83 (2.4%) and the rest of the dysglycemic study participants had normal blood glucose levels. None of the study participants had persistent hypoglycemia at 24 hours. The cumulative mortality at 48hours was 3/ 83(3.6%). A total of 27/83 (32.2%) dysglycemic participants were discharged from the hospital at 48 hours after normalization of blood glucose levels. Of those discharged, 24 (29%) had hypoglycemia whereas 3 (3.6%) had hyperglycemia at admission. After multiple logistic regression, obstructed breathing (AOR 0.07(0.02-0.23), inability to breastfeed/drink (AOR 2.40 (1.17-4.92) and active convulsions (AOR 0.21 (0.06-0.74), were the factors that were significantly associated with dysglycemia among critically ill children. Conclusions Dysglycemia is a common disorder affecting one in five critically ill children aged one month to 12 years presenting to Fort Portal Regional Referral Hospital. Dysglycemia outcomes are good with early intervention among critically ill children. Recommendations 1. Critically ill children with dysglycemia who present with inability to feed should be prioritized for clinical care in emergency settings by the clinical team. The interpretation of the findings of obstructed breathing and active convusions should interpreted with caution given that the study was done in an era of COVID19 pandemic where transport restrictions were tight. 2. A larger prospective study among critically ill children would be necessary to determine the long-term outcome of dysglycemia . 3. The availability of bedside diagnostic tools to measure blood sugar levels may accelerate clinical decision-making in the management of critically ill children with dysglycemia in resource-constrained settings. Every critically ill child with emergency signs should have blood glucose levels monitored regularly during their hospital stay by the clinicians.