Hypothesis: Normalisation of cytokine dysbalance explains the favourable effects of strict glucose regulation in the critically ill.
Recent trials investigating the effects of strict glucose regulation in critically ill patients have shown impressive reductions in morbidity and mortality. Although the literature focuses on the possible toxic effects of high blood glucose levels, the underlying mechanism for this improvement is unclear. We hypothesise that strict glucose regulation results in modulation of cytokine production, leading to a shift towards a more anti-inflammatory pattern. This shift in the cytokine balance accounts for the reduction in morbidity and mortality. To support our hypothesis, effects of glucose and insulin on cytokine release and effects of glucose, insulin, and cytokines on host defence, cardiac function and coagulation will be reviewed.
Pickkers
P
P
Department of Intensive Care Medicine (519), University Medical Centre St Radboud, Nijmegen, The Netherlands. p.pickkers@ic.umcn.nl
Hoedemaekers
A
A
Netea
M G
MG
de Galan
B E
BE
Smits
P
P
van der Hoeven
J G
JG
van Deuren
M
M
D001777:Blood Coagulation / Q000502:physiology*; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness; D016207:Cytokines / Q000378:metabolism* / Q000502:physiology; D005947:Glucose / Q000502:physiology; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006943:Hyperglycemia / Q000503:physiopathology*; D007328:Insulin / Q000502:physiology
D001786:Blood Glucose; D016207:Cytokines; D007328:Insulin; D005947:Glucose