Effect of insulin therapy on coagulation and fibrinolysis in medical intensive care patients.
OBJECTIVE
Most intensive care deaths beyond the first few days of critical illness are attributable to nonresolving organ failure, either due to or coinciding with sepsis. One of the mechanisms that is thought to contribute to the pathogenesis of organ failure is microvascular thrombosis. Recently, we reported significant improved survival and prevention of organ failure with the use of intensive insulin therapy to maintain normoglycemia for at least several days. We hypothesize that intensive insulin therapy also prevents severe coagulation abnormalities thereby contributing to less organ failure and better survival.


METHODS
This was a preplanned subanalysis of a large randomized controlled study, conducted at a university hospital medical intensive care unit. The intervention was strict blood glucose control to normoglycemia with insulin.


RESULTS
Mortality of intensive insulin-treated patients was lower than that of conventionally treated patients for all classes of upon-admission disseminated intravascular coagulation (DIC) scores, except for those patients with overt DIC scores of 6 or higher (for DIC < 5, p = 0.003; for DIC > or = 5, p = 0.4). There was no effect of insulin therapy on any of the fibrinolytic, coagulation, or inflammatory parameters tested.


CONCLUSIONS
This negative observation does not support a key role for these systems in explaining the clinical benefit of intensive insulin therapy, although a short-lived effect within 5 days of treatment cannot be excluded.
Langouche
Lies
L
Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Leuven, Belgium.
Meersseman
Wouter
W
Vander Perre
Sarah
S
Milants
Ilse
I
Wouters
Pieter J
PJ
Hermans
Greet
G
Gjedsted
Jakob
J
Hansen
Troels K
TK
Arnout
Jozef
J
Wilmer
Alexander
A
Schetz
Miet
M
Van den Berghe
Greet
G
D000368:Aged; D001777:Blood Coagulation / Q000187:drug effects*; D003422:Critical Care; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged
D007328:Insulin