Tight glycemic control does not affect asymmetric-dimethylarginine in septic patients.
OBJECTIVE
We investigated whether preventing hyperglycemia in septic patients affected the plasma concentration of asymmetric-dimethylarginine and if this was associated with clinical benefit.


METHODS
A prospective, multicenter, randomized, controlled, clinical study.


METHODS
Intensive care units (ICU) in three university hospitals.


METHODS
A total of 72 patients admitted for severe sepsis or septic shock, who stayed at least 3 days in the ICU. At admission the patients were assigned to receive either tight or conventional glycemic control.


METHODS
Determination of circulating levels of asymmetric-dimethylarginine, arginine, interleukin-6, C-reactive-protein and tumor-necrosis-factor-alpha.


RESULTS
Blood was sampled at admission (no differences between groups), and on the 3rd, 6th, 9th, and 12th (T12) days. Sequential organ failure assessment was scored at each sampling time. All the data were analyzed on an intention-to-treat basis. The control and treatment groups received the same energy intake, glycemia (110.4 +/- 17.3 vs. 163.0 +/- 28.9 mg/dL, P < 0.001) and insulin (P = 0.02) supply differed. No differences were found in high plasma levels of asymmetric-dimethylarginine (P = 0.812) at any time during the ICU stay. The clinical course, as indicated by markers of inflammation, average and maximum organ failure score, ICU stay and ICU and 90-day mortality, was the same.


CONCLUSIONS
Intensive insulin treatment, while achieving glucose control, did not reduce asymmetric-dimethylarginine in high-risk septic patients fed with no more than 25 kcal/kg per day to limit ventilatory demand and to simplify glucose control.


BACKGROUND
45 (SIRS/sepsis: clinical studies).
Iapichino
Gaetano
G
Istituto di Anestesiologia e Rianimazione, Università degli Studi di Milano, via A. Di Rudinì 8, 20142 Milan, Italy. g.iapichino@unimi.it
Albicini
Maura
M
Umbrello
Michele
M
Sacconi
Francesca
F
Fermo
Isabella
I
Pavlovich
Radmila
R
Paroni
Rita
R
Bellani
Giacomo
G
Mistraletti
Giovanni
G
Cugno
Massimo
M
Pesenti
Antonio
A
Gattinoni
Luciano
L
D000368:Aged; D001120:Arginine / Q000031:analogs & derivatives* / Q000097:blood; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000097:blood / Q000150:complications*; D016896:Treatment Outcome
D007004:Hypoglycemic Agents; D007328:Insulin; C487735:dimethylarginine; D001120:Arginine