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

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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.

Setting

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).

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Acknowledgments

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.

Author information

Authors and Affiliations

  1. Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, via A. Di Rudinì 8, 20142, Milan, Italy

    Gaetano Iapichino, Michele Umbrello, Francesca Sacconi, Giovanni Mistraletti & Luciano Gattinoni

  2. U.O. Anestesia e Rianimazione, Azienda Ospedaliera Polo Universitario San Paolo, Milan, Italy

    Maura Albicini

  3. Dipartimento di Medicina Perioperatoria e Terapia Intensiva, Azienda Ospedaliera San Gerardo di Monza, Dipartimento di Medicina Sperimentale, Università degli Studi Milano-Bicocca, Milan, Italy

    Giacomo Bellani & Antonio Pesenti

  4. Department of Medicine, Surgery, Dental Science, University of Milan, Polo San Paolo, Milan, Italy

    Radmila Pavlovich & Rita Paroni

  5. Separative Techniques Unit, San Raffaele Scientific Institute, Milan, Italy

    Isabella Fermo

  6. Department of Internal Medicine, University of Milan, Fondazione IRCCS, Ospedale Maggiore Policlinico, Mangiagalli, Regina Elena, Milan, Italy

    Massimo Cugno

Authors
  1. Gaetano Iapichino
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  2. Maura Albicini
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  3. Michele Umbrello
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  4. Francesca Sacconi
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  5. Isabella Fermo
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  6. Radmila Pavlovich
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  7. Rita Paroni
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  8. Giacomo Bellani
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  9. Giovanni Mistraletti
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  10. Massimo Cugno
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  11. Antonio Pesenti
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  12. Luciano Gattinoni
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Corresponding author

Correspondence to Gaetano Iapichino.

Additional information

The study was supported in part by a grant from Ministero dell’Università e Ricerca Scientifica FIRST 2005/2007.

None of the authors have any financial interests to disclose.

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Iapichino, G., Albicini, M., Umbrello, M. et al. Tight glycemic control does not affect asymmetric-dimethylarginine in septic patients. Intensive Care Med 34, 1843–1850 (2008). https://doi.org/10.1007/s00134-008-1158-9

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  • DOI: https://doi.org/10.1007/s00134-008-1158-9

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