Dyslipidemia: a prospective controlled  randomized trial of intensive glycemic  control in sepsis.
OBJECTIVE
Metabolic disturbances are quite common in critically ill patients. Glycemic control appears to be an important adjuvant therapy in such patients. In addition, disorders of lipid metabolism are associated with worse prognoses. The purpose of this study was to investigate the effects that two different glycemic control protocols have on lipid profile and metabolism.


METHODS
We evaluated 63 patients hospitalized for severe sepsis or septic shock, over the first 72 h of intensive care. Patients were randomly allocated to receive conservative glycemic control (target range 140–180 mg/dl) or intensive glycemic control (target range 80–110 mg/dl). Serum levels of lowdensity lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, free fatty acids, and oxidized low-density lipoprotein were determined.


RESULTS
In both groups, serum levels of low-density lipoprotein, high-density lipoprotein, and total cholesterol were below normal, whereas those of free fatty acids, triglycerides, and oxidized lowdensity lipoprotein were above normal. At 4 h after admission, free fatty acid levels were higher in the conservative group than in the intensive group, progressively decreasing in both groups until hour 48 and continuing to decrease until hour 72 only in the intensive group. Oxidized low-density lipoprotein levels were elevated in both groups throughout the study period.


CONCLUSIONS
Free fatty acids respond to intensive glycemic control and, because of their high toxicity, can be a therapeutic target in patients with sepsis.
Laboratório da Disciplina de Emergências Clínicas, Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Arnaldo 455, sala 3187, São Paulo, SP 01246-913, Brazil.
Sylas B
SB
Cappi
Danilo T
DT
Noritomi
Irineu T
IT
Velasco
Rui
R
Curi
Tatiana C A
TC
Loureiro
Francisco G
FG
Soriano
D018806:APACHE; D001786:Blood Glucose / Q000032:analysis*; D002784:Cholesterol / Q000097:blood; D003124:Colorimetry; D050171:Dyslipidemias / Q000150:complications* / Q000517:prevention & control*; D004797:Enzyme-Linked Immunosorbent Assay; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018805:Sepsis / Q000097:blood*; D018709:Statistics, Nonparametric; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; C099252:oxidized low density lipoprotein; D002784:Cholesterol