Intensive Care Medicine

, Volume 38, Issue 4, pp 634–641

Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

  • Sylas B. Cappi
  • Danilo T. Noritomi
  • Irineu T. Velasco
  • Rui Curi
  • Tatiana C. A. Loureiro
  • Francisco G. Soriano
Original

DOI: 10.1007/s00134-011-2458-z

Cite this article as:
Cappi, S.B., Noritomi, D.T., Velasco, I.T. et al. Intensive Care Med (2012) 38: 634. doi:10.1007/s00134-011-2458-z

Abstract

Purpose

Metabolic disturbances are quite common in critically ill patients. Glycemic control appears to be an important adjuvant therapy in such patients. In addition, disorders of lipid metabolism are associated with worse prognoses. The purpose of this study was to investigate the effects that two different glycemic control protocols have on lipid profile and metabolism.

Methods

We evaluated 63 patients hospitalized for severe sepsis or septic shock, over the first 72 h of intensive care. Patients were randomly allocated to receive conservative glycemic control (target range 140–180 mg/dl) or intensive glycemic control (target range 80–110 mg/dl). Serum levels of low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, free fatty acids, and oxidized low-density lipoprotein were determined.

Results

In both groups, serum levels of low-density lipoprotein, high-density lipoprotein, and total cholesterol were below normal, whereas those of free fatty acids, triglycerides, and oxidized low-density lipoprotein were above normal. At 4 h after admission, free fatty acid levels were higher in the conservative group than in the intensive group, progressively decreasing in both groups until hour 48 and continuing to decrease until hour 72 only in the intensive group. Oxidized low-density lipoprotein levels were elevated in both groups throughout the study period.

Conclusions

Free fatty acids respond to intensive glycemic control and, because of their high toxicity, can be a therapeutic target in patients with sepsis.

Keywords

Blood glucoseSepsisFatty acidsNonesterifiedLipids

Supplementary material

134_2011_2458_MOESM1_ESM.ppt (119 kb)
Supplementary material 1 (PPT 119 kb)
134_2011_2458_MOESM2_ESM.ppt (118 kb)
Supplementary material 2 (PPT 118 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Sylas B. Cappi
    • 1
  • Danilo T. Noritomi
    • 1
  • Irineu T. Velasco
    • 1
  • Rui Curi
    • 3
  • Tatiana C. A. Loureiro
    • 3
  • Francisco G. Soriano
    • 1
    • 2
  1. 1.Laboratório da Disciplina de Emergências ClínicasFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
  2. 2.Intensive Care UnitUniversity of São Paulo University HospitalSão PauloBrazil
  3. 3.Institute of Biomedical SciencesUniversity of São PauloSão PauloBrazil