• Dieter Mesotten, Joost Wauters, Greet Van den Berghe, Pieter J Wouters, Ilse Milants, and Alexander Wilmer.
• Department of Intensive Care Medicine, University Hospitals of the Katholieke Universiteit Leuven, B-3000 Leuven, Belgium. dieter.mesotten@med.kuleuven.be
• J. Clin. Endocrinol. Metab. 2009 Jul 1; 94 (7): 2345-52.

Background And AimsCholestatic liver dysfunction and biliary sludge are common problems in critically ill patients. No specific strategies have been described to prevent cholestasis and biliary sludge in the intensive care unit (ICU). We examined liver dysfunction and biliary sludge prospectively in a large medical long-stay ICU population and hypothesized that tight glycemic control with intensive insulin therapy (IIT) reduces cholestasis and biliary sludge.MethodsThis study was a preplanned subanalysis of 658 long-stay (at least a fifth day) ICU patients out of a large randomized controlled trial (n = 1200), studying the effects of IIT on the outcome of medical critical illness. Patients were allocated to either IIT (glycemia 80-110 mg/dl) or conventional insulin therapy (CIT) requiring insulin above a glycemia of 215 mg/dl. Different patterns of liver dysfunction were studied based on daily blood sample analysis, and biliary sludge was evaluated by ultrasonography.ResultsOn admission, cholestasis was present in 17% of patients (n = 649), increasing to 20% on d 10 (n = 347), whereas ischemic hepatitis decreased from 3.4% (n = 588) to less than 1% (n = 328). IIT significantly decreased biliary sludge on d 5 (50.4 vs. 66.4%, P = 0.01; n = 250). The difference did not remain significant on d 10 (57.4 vs. 66.2%, P = 0.29; n = 136). IIT also lowered the cumulative risk of cholestasis (P = 0.03).ConclusionsCholestatic liver dysfunction and biliary sludge are very common during prolonged critical illness but are significantly reduced by IIT.

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