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Extracellular metabolic alterations in critically ill septic patients studied by adipose tissue microdialysis
Critical Care volume 14, Article number: P31 (2010)
Tissue metabolic alterations during critical sepsis have not been well characterized.
To investigate the tissue metabolic alterations during sepsis.
A microdialysis (MD) catheter was inserted into the subcutaneous adipose tissue of the upper thigh in 65 (39 men) septic critically ill patients upon sepsis onset. Dialysate samples were analyzed for glucose, lactate, pyruvate, and glycerol. The lactate/pyruvate (L/P) ratio was calculated. Sampling was performed six times per day for a maximum of 6 days. The daily mean values of MD measurements were calculated for each patient. Eleven (five men) critically ill nonseptic patients served as controls.
Septic patients were older (66 ± 17 vs. 45 ± 20 years, P < 0.001), and had a higher APACHE II score (21 ± 5 vs. 14 ± 6, P < 0.001) along with a higher SOFA score (8 ± 3 vs. 3 ± 3, P < 0.001) compared with nonseptic patients. Septic patients had a high tissue glucose ( > 4.6 mmol/l), lactate ( > 2 mmol/l), pyruvate ( > 120 μmol/l), L/P ratio ( > 25), and glycerol ( > 200 μmol/l) during almost the entire observation period. Septic patients had higher tissue glucose (P = 0.02) and glycerol (P = 0.04) levels than nonseptic patients during the whole study period. They also tended to have higher lactate (P = 0.14) concentrations. In contrast, the two groups had similar tissue pyruvate (P = 0.35) and L/P ratios (P = 0.80).
Critical sepsis is characterized by an excessive release of extracellular glucose, lactate, and glycerol, with the latter reflecting probably increased lipolysis. These mirror the well-known sepsis-related blood metabolic alterations. Thus, chemical monitoring with subcutaneous MD is accurate in severely ill septic patients.
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Theodorakopoulou, M., Nikitas, N., Orfanos, S. et al. Extracellular metabolic alterations in critically ill septic patients studied by adipose tissue microdialysis. Crit Care 14, P31 (2010). https://doi.org/10.1186/cc9134
- Adipose Tissue
- Septic Patient
- Subcutaneous Adipose Tissue