Tight glycemic control does not affect asymmetric-dimethylarginine in septic patients

Gaetano Iapichino, Maura Albicini, Michele Umbrello, Francesca Sacconi, Isabella Fermo, Radmila Pavlovich, Rita Paroni, Giacomo Bellani, Giovanni Mistraletti, Massimo Cugno, Antonio Pesenti, Luciano Gattinoni

Research output: Contribution to journalArticle

Abstract

Objective: We investigated whether preventing hyperglycemia in septic patients affected the plasma concentration of asymmetric-dimethylarginine and if this was associated with clinical benefit. Design: A prospective, multicenter, randomized, controlled, clinical study. Intensive care units (ICU) in three university hospitals. Patients: A total of 72 patients admitted for severe sepsis or septic shock, who stayed at least 3 days in the ICU. At admission the patients were assigned to receive either tight or conventional glycemic control. Interventions: Determination of circulating levels of asymmetric- dimethylarginine, arginine, interleukin-6, C-reactive-protein and tumor-necrosis-factor-α. Measurements and results: Blood was sampled at admission (no differences between groups), and on the 3rd, 6th, 9th, and 12th (T12) days. Sequential organ failure assessment was scored at each sampling time. All the data were analyzed on an intention-to-treat basis. The control and treatment groups received the same energy intake, glycemia (110.4 ± 17.3 vs. 163.0 ± 28.9 mg/dL, P <0.001) and insulin (P = 0.02) supply differed. No differences were found in high plasma levels of asymmetric-dimethylarginine (P = 0.812) at any time during the ICU stay. The clinical course, as indicated by markers of inflammation, average and maximum organ failure score, ICU stay and ICU and 90-day mortality, was the same. Conclusions: Intensive insulin treatment, while achieving glucose control, did not reduce asymmetric-dimethylarginine in high-risk septic patients fed with no more than 25 kcal/kg per day to limit ventilatory demand and to simplify glucose control. Descriptor: 45 (SIRS/sepsis: clinical studies).

Original languageEnglish
Pages (from-to)1843-1850
Number of pages8
JournalIntensive Care Medicine
Volume34
Issue number10
DOIs
Publication statusPublished - Oct 2008

Keywords

  • ADMA
  • Endocrine
  • Glycemic control
  • Insulin therapy
  • Sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Iapichino, G., Albicini, M., Umbrello, M., Sacconi, F., Fermo, I., Pavlovich, R., Paroni, R., Bellani, G., Mistraletti, G., Cugno, M., Pesenti, A., & Gattinoni, L. (2008). Tight glycemic control does not affect asymmetric-dimethylarginine in septic patients. Intensive Care Medicine, 34(10), 1843-1850. https://doi.org/10.1007/s00134-008-1158-9