Blood glucose and prognosis in children with presumed severe malaria: is there a threshold for 'hypoglycaemia'?

Summary objectives Hypoglycaemia (glucose 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.