Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?
OBJECTIVES: Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. METHODS: A prospective study of 437 consecutive children with presumed severe malari...
| Κύριοι συγγραφείς: | , , , , , |
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| Μορφή: | Journal article |
| Γλώσσα: | English |
| Έκδοση: |
2010
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| _version_ | 1826287055113551872 |
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| author | Willcox, M Forster, M Dicko, M Graz, B Mayon-White, R Barennes, H |
| author_facet | Willcox, M Forster, M Dicko, M Graz, B Mayon-White, R Barennes, H |
| author_sort | Willcox, M |
| collection | OXFORD |
| description | OBJECTIVES: Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. METHODS: A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). RESULTS: There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). CONCLUSIONS: If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l. |
| first_indexed | 2024-03-07T01:52:53Z |
| format | Journal article |
| id | oxford-uuid:9ab97a2e-05e3-4a3e-b07c-9fc3e56fabd0 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T01:52:53Z |
| publishDate | 2010 |
| record_format | dspace |
| spelling | oxford-uuid:9ab97a2e-05e3-4a3e-b07c-9fc3e56fabd02022-03-27T00:23:21ZBlood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:9ab97a2e-05e3-4a3e-b07c-9fc3e56fabd0EnglishSymplectic Elements at Oxford2010Willcox, MForster, MDicko, MGraz, BMayon-White, RBarennes, H OBJECTIVES: Hypoglycaemia (glucose <2.2 mmol/l) is a defining feature of severe malaria, but the significance of other levels of blood glucose has not previously been studied in children with severe malaria. METHODS: A prospective study of 437 consecutive children with presumed severe malaria was conducted in Mali. We defined hypoglycaemia as <2.2 mmol/l, low glycaemia as 2.2-4.4 mmol/l and hyperglycaemia as >8.3 mmol/l. Associations between glycaemia and case fatality were analysed for 418 children using logistic regression models and a receiver operator curve (ROC). RESULTS: There was a significant difference between blood glucose levels in children who died (median 4.6 mmol/l) and survivors (median 7.6 mmol/l, P < 0.001). Case fatality declined from 61.5% of the hypoglycaemic children to 46.2% of those with low glycaemia, 13.4% of those with normal glycaemia and 7.6% of those with hyperglycaemia (P < 0.001). Logistic regression showed an adjusted odds ratio (AOR) of 0.75 (0.64-0.88) for case fatality per 1 mmol/l increase in baseline blood glucose. Compared to a normal blood glucose, hypoglycaemia and low glycaemia both significantly increased the odds of death (AOR 11.87, 2.10-67.00; and 5.21, 1.86-14.63, respectively), whereas hyperglycaemia reduced the odds of death (AOR 0.34, 0.13-0.91). The ROC [area under the curve at 0.753 (95% CI 0.684-0.820)] indicated that glycaemia had a moderate predictive value for death and identified an optimal threshold at glycaemia <6.1 mmol/l, (sensitivity 64.5% and specificity 75.1%). CONCLUSIONS: If there is a threshold of blood glucose which defines a worse prognosis, it is at a higher level than the current definition of 2.2 mmol/l. |
| spellingShingle | Willcox, M Forster, M Dicko, M Graz, B Mayon-White, R Barennes, H Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title | Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title_full | Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title_fullStr | Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title_full_unstemmed | Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title_short | Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'? |
| title_sort | blood glucose and prognosis in children with presumed severe malaria is there a threshold for hypoglycaemia |
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