Clinical study of low C-peptide level in critically ill children

doi:10.3969/j.issn.1002-1949.2015.03.018

Abstract：Objective To analyze the variation of serum C -peptide levels in critically ill children and to investigate the underlying mechanism and clinical significance.Methods Two hundred and fifty-six critically ill children admitted in pediatric intensive care unit ( PICU) of Hunan Children's Hospital from November 2012 to June 2013 were included.The low C-peptide group ( n=256 ) was defined as insulin levels within 24 h and the patients were divided into two groups according to C -peptide level:mildly declined group (n=174):0.39~0.78 ng/mL;severe declined group (n=82):<0.39 ng/mL.C-peptide, insulin and blood glucose were measured within 24 hours after admission, and on day 3 and day 7.Other results about inflammatory markers, lactate, cardiac enzymes, amylase, pancreatic ultrasound, hepatic and renal function as well as indicators related to severity and prognosis were recorded after admission.Results ①The C -peptide level peak was seen on day 1, then presented a downward trend and closed to the normal level on day 7; ②The blood glucose and insulin level peaks were seen on day 1 then declined, the levels on days 7 were still slightly higher than the normal levels;③The C-peptide level was negatively correlated to WBC, lactic acid and procalcitonin level, and positively correlated Ca2+, oxidation index ( P <0.01); ④Albumin and PCIS levels in severe declined group were lower than those in mildly declined group, but ALT, AST, LDH and CK-MB levels in severe declined group were higher than those in mildly declined group (P<0.05);⑤The incidence of severe sepsis, septic shock and MODS in severe declined group were higher than that in mildly declined group ( P <0.05); ⑥Seven cases in death group were complicated with pancreatic damage and the average C-peptide level at admission was (0.34 ±0.12) ng/mL.Conclusion The low C-peptide level is correlated to the degree of inflammatory response, ischemia and hypoxia.The low C-peptide level in critically ill children is relevant to the pancreatic damage, the severity of the disease, organ dysfunction, and evaluation of prognosis.