Abstract 13917: A Pro-Inflammatory, Hyperinsulin State, Not Hyperglycemia, is Associated With Adverse Outcomes After Pediatric Heart Surgery

Introduction: Hyperglycemia following CPB for congenital heart disease (CHD) may be associated with poor outcomes. This may be due to an insulin resistant, pro-inflammatory state and not directly to hyperglycemia, but this has not been studied. Hypothesis: The combination of high insulin levels and a heightened inflammatory state is associated with impaired cardiac output and adverse clinical outcomes following CPB for CHD. Methods: Children undergoing CPB for CHD were prospectively enrolled. Plasma hormone and cytokine levels were measured for up to 72 hours following surgery and results were log transformed for analysis. A subset of children in the ICU had cardiac index (CI) measured by respiratory mass spectrometry. Data on standard clinical outcomes were recorded. Results: 157 children (mean age 3.6 years, IQR 0.33-4.44) were enrolled. 31% had peak glucose 180-270 mg/dL and 17% > 270 mg/dL. 22 subjects (14%) reached the composite adverse outcome consisting of shock, seizures, renal or hepatic dysfunct...