Endocrine Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.

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    • Subject Terms:
      GLUCOSE metabolism; CONSENSUS (Social sciences); BIOMARKERS; ONLINE information services; HOMEOSTASIS; ENDOCRINE diseases; MEDICAL information storage & retrieval systems; ADRENAL glands; CRITICALLY ill; FUNCTIONAL status; SYSTEMATIC reviews; THYROXINE; PATIENTS; CONFERENCES & conventions; GLUCOSE metabolism disorders; BLOOD sugar; TERMS & phrases; MEDLINE; ENDOCRINE system; THYROID gland; HYDROCORTISONE; ADRENOCORTICOTROPIC hormone; CHILDREN; SYMPTOMS
    • Abstract:
      CONTEXT: Endocrine dysfunction is common in critically ill children and is manifested by abnormalities in glucose, thyroid hormone, and cortisol metabolism. OBJECTIVE: To develop consensus criteria for endocrine dysfunction in critically ill children by assessing the association of various biomarkers with clinical and functional outcomes. DATA SOURCES: PubMed and Embase were searched from January 1992 to January 2020. STUDY SELECTION: We included studies in which researchers evaluated critically ill children with abnormalities in glucose homeostasis, thyroid function and adrenal function, performance characteristics of assessment and/or scoring tools to screen for endocrine dysfunction, and outcomes related to mortality, organ-specific status, and patient-centered outcomes. Studies of adults, premature infants or animals, reviews and/or commentaries, case series with sample size ≤10, and non--English-language studies were excluded. DATA EXTRACTION: Data extraction and risk-of-bias assessment for each eligible study were performed by 2 independent reviewers. RESULTS: The systematic review supports the following criteria for abnormal glucose homeostasis (blood glucose [BG] concentrations >150 mg/dL [>8.3 mmol/L] and BG concentrations <50 mg/dL [<2.8 mmol/L]), abnormal thyroid function (serum total thyroxine [T4] <4.2 µg/dL [<54 nmol/L]), and abnormal adrenal function (peak serum cortisol concentration <18 µg/dL [500 nmol/L]) and/or an increment in serum cortisol concentration of <9 µg/dL (250 nmol/L) after adrenocorticotropic hormone stimulation. LIMITATIONS: These included variable sampling for BG measurements, limited reporting of free T4 levels, and inconsistent interpretation of adrenal axis testing. CONCLUSIONS: We present consensus criteria for endocrine dysfunction in critically ill children that include specific measures of BG, T4, and adrenal axis testing. [ABSTRACT FROM AUTHOR]
    • Abstract:
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