Impaired glucose and lipid metabolism seen in intensive care patients is related to severity of illness and survival.
OBJECTIVE
To relate glucose and lipid metabolism to the severity of illness and survival in critically ill patients.


METHODS
Cross-sectional and prospective cohort study.


METHODS
Secondary referral ICU.


METHODS
Forty-four consecutive patients admitted to the ICU.


RESULTS
An 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.


CONCLUSIONS
In 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.
Lind
L
L
Department of Medicine, Uppsala University Hospital, Sweden.
Lithell
H
H
D018806:APACHE; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D016638:Critical Illness / Q000401:mortality; D003430:Cross-Sectional Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015996:Survival Rate; D014280:Triglycerides / Q000097:blood