Lipid metabolism and organ dysfunction in septic patients during intensive glycemic control

Introduction

Intensive glycemic control has been widely discussed in critical care patients. It remains unclear whether intensive insulin therapy also improves the prognosis of patients in a medical ICU, who often are more severely ill than are patients in a surgical ICU and have a higher risk of death. Recently, medical patients have been investigated, as a special group. We decided to study possible differences in lipid profile in septic shock patients during the first 72 hours and correlate it with different organ dysfunctions.

Methods

A prospective, randomized, controlled study in a 12-bed medico-surgical ICU in a university hospital. Inclusion criteria: all consecutive patients admitted to the ICU with severe sepsis and or septic shock with onset in a maximum of 24 hours. Exclusion criteria: HIV patients, pregnancy, diagnosis of leptospirosis, age under 18, cancer patients. On admission, patients were randomly assigned to strict normalization of blood glucose levels (80–110 mg/dl) or to a conventional glycemic control (180–220 mg/dl) with the use of sealed envelopes. We collected laboratory tests at 0, 24, 48 and 72 hours after initiation. For statistical analysis we performed the Student t test.

Results

We studied 58 patients with similar demographic data between the two groups. The increases in serum LDL (P < 0.05) and HDL (not significant) were different between groups. The mortality rate was the same but LDL and HDL had negative correlation with organ function among nonsurvivors.

Conclusion

Targeting blood glucose levels to below 110 mg/dl with insulin therapy prevented morbidity, probably due to a better control of lipid metabolism, expressed as a more rapid serum LDL normalization and avoiding a greater decrease in serum HDL levels in the first 72 hours of septic shock.

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