• Clin Intensive Care · Jan 1994

    Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.

    • L Lind and H Lithell.
    • Department of Medicine, Uppsala University Hospital, Sweden.
    • Clin Intensive Care. 1994 Jan 1;5(3):100-5.

    ObjectiveTo relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients.DesignCross-sectional and prospective cohort study.SettingSecondary referral ICU.PatientsForty-four consecutive patients admitted to the ICU.Measurements And Main ResultsAn intravenous glucose tolerance test (IVGTT) and serum lipoprotein determinations were performed within the first 24 hours in the ICU. An APACHE II score was also determined. Basal serum lactate, glucose and insulin were all elevated in ICU patients compared to healthy controls (p < 0.001) and were all correlated to indices of severity of illness (r = 0.36-0.42, p < 0.05-0.01 vs the APACHE II score). However, the early insulin response to IVGTT was inversely correlated to the APACHE II score (r = -0.50, p < 0.01). Triglyceride and cholesterol levels in serum were generally decreased when compared to controls (0.88 +/- 0.63 mmol/l for serum triglycerides and 2.46 +/- 0.97 mmol/l for serum cholesterol, p < 0.01 vs controls). However, as could be judged from the levels of free serum glycerol (0.27 +/- 0.23 mmol/l), lipolysis was increased in the critically ill. Serum triglyceride levels, as well as serum FFA and glycerol, correlated to the severity of illness (r = 0.36-0.62, p < 0.05-0.001), HDL-cholesterol was inversely related to the APACHE II score (r = -0.40, p < 0.05). Serum glucose, FFA, glycerol and triglycerides in serum, VLDL and LDL were all elevated (p < 0.05-0.001), while HDL-cholesterol was decreased (p < 0.05) in septic patients (n = 17) compared to those without sepsis. Serum lactate (p < 0.05) and free glycerol (p < 0.01) were both elevated in patients who did not survive (n = 6) when compared to survivors. Multiple logistic regression analysis showed free glycerol (p < 0.05) to be additive to the APACHE II score (p < 0.01) in predicting mortality.ConclusionIn a sample of unselected critically ill patients indices of both glucose and lipid metabolism were found to be related to the severity of illness as well as to the occurrence of sepsis and survival.

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