Intensive Care Medicine

, 34:1843 | Cite as

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

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



We investigated whether preventing hyperglycemia in septic patients affected the plasma concentration of asymmetric-dimethylarginine and if this was associated with clinical benefit.


A prospective, multicenter, randomized, controlled, clinical study.


Intensive care units (ICU) in three university hospitals.


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.


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.


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.


45 (SIRS/sepsis: clinical studies).


ADMA Sepsis Glycemic control Insulin therapy Endocrine 



We thank Alberto Morabito, Professor of Medical Statistics, Università degli Studi di Milano, for the accurate revision of the statistical analysis of the study. We are grateful to J. D. Baggott for editing the English.


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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Gaetano Iapichino
    • 1
    Email author
  • Maura Albicini
    • 2
  • Michele Umbrello
    • 1
  • Francesca Sacconi
    • 1
  • Isabella Fermo
    • 5
  • Radmila Pavlovich
    • 4
  • Rita Paroni
    • 4
  • Giacomo Bellani
    • 3
  • Giovanni Mistraletti
    • 1
  • Massimo Cugno
    • 6
  • Antonio Pesenti
    • 3
  • Luciano Gattinoni
    • 1
  1. 1.Istituto di Anestesiologia e RianimazioneUniversità degli Studi di MilanoMilanItaly
  2. 2.U.O. Anestesia e RianimazioneAzienda Ospedaliera Polo Universitario San PaoloMilanItaly
  3. 3.Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, Dipartimento di Medicina SperimentaleUniversità degli Studi Milano-BicoccaMilanItaly
  4. 4.Department of Medicine, Surgery, Dental ScienceUniversity of MilanMilanItaly
  5. 5.Separative Techniques UnitSan Raffaele Scientific InstituteMilanItaly
  6. 6.Department of Internal MedicineUniversity of Milan, Fondazione IRCCS, Ospedale Maggiore PoliclinicoMilanItaly

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