Abstract:

Objective To investigate the relationship between serum insulin level and the severity and prognosis of sepsis associated encephalopathy (SAE) in children. Methods The clinical data of children with sepsis admitted to the children's critical care unit from January 2019 to December 2020 were retrospectively analyzed. According to the score of confusion assessment method for the ICU (CAM-ICU) or EEG results, the children were divided into SAE group and non-SAE group, and then SAE group was divided into mild to moderate group and severe group. Clinical indicators were compared among different groups. Results A total of 47 children (28 boys and 19 girls) were included and the median age was 24 (12-45) months. The primary sources of infection were respiratory system (21 cases), digestive system (15 cases), urinary system (3 cases) and other systems (8 cases). There were 25 cases in the non-SAE group and 22 cases in the SAE group, including 16 cases in the mild to moderate SAE group and 6 cases in the severe SAE group. Thirty-one children survived and 16 died. Hyperinsulinemia occurred in 18 children (38.3%) within 24 hours after admission. Compared with non-SAE group, SAE group had higher serum insulin, S100β protein and procalcitonin (PCT) levels, higher incidence of hyperinsulinemia, and lower Glasgow Coma Scale, and the differences were statistically significant (P<0.05). There was significant difference in serum insulin levels at admission among non-SAE group, mild to moderate SAE group and severe SAE group (P<0.05), of which the severe SAE group had the highest level of serum insulin. Serum insulin level was positively correlated with S100β level (r_s=0.53, P<0.001) and negatively correlated with Glasgow Coma Scale (r_s =-0.59, P<0.001). Compared with the survival group, the incidence of hyperinsulinemia and serum insulin level in the death group were significantly higher (P<0.05). Conclusion Hyperinsulinemia has a high incidence in children with SAE. Dynamic monitoring of serum insulin level is of great clinical significance to evaluate the prognosis of children with SAE.

Key words: sepsis associated encephalopathy, hyperinsulinemia, prognosis, child