title: Association between early glycemic control and improvements in markers of coagulation and fibrinolysis in patients with septic shock-induced stress hyperglycemia.
abstract: OBJECTIVE
  The purpose of this study is to evaluate the coagulation and inflammatory profiles in septic shock patients with baseline hyperglycemia under glycemic control.
  
  
  METHODS
  Prospective, observational study conducted in an intensive care unit of a university hospital, including 41 septic shock nondiabetic patients with hyperglycemia (n = 21) or normoglycemia (n = 20) profiles at baseline. Hyperglycemic patients received a glucose control protocol (target glycemia, <150 mg/dL). Metabolic, inflammatory, and coagulation markers were measured at baseline and after 24 hours.
  
  
  RESULTS
  Median glycemic values between groups were different at baseline but not after 24 hours. Baseline coagulation profile was similar in both groups with elevated levels of coagulation markers, reduced factor VII, protein C, and antithrombin activities and fibrinolysis impairment. Normoglycemic patients had unchanged coagulation markers after 24 hours. After treatment, previously hyperglycemic patients exhibited increased plasminogen concentrations (P = .03) and reduced levels of plasminogen activator inhibitor 1 (P = .01) and tissue plasminogen activator (P = .03) as compared with baseline. They also had higher factor VII (P = .03), protein C (P = .04), and antithrombin (P = .04) activities than normoglycemic patients. Inflammatory markers were elevated in both groups and improved after 24 hours, independently of the glycemic profile.
  
  
  CONCLUSIONS
  Glycemic control during septic shock is associated with improvements in coagulation and fibrinolysis parameters compared with baseline and normoglycemic patients.
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Luciana Coelho
authors.initials: LC
authors.lastname: Sanches
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Luciano Cesar
authors.initials: LC
authors.lastname: Pontes Azevedo
authors.affiliation: Infectious Disease Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Salomão
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Maria Aparecida
authors.initials: MA
authors.lastname: Noguti
authors.affiliation: Infectious Disease Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Milena
authors.initials: M
authors.lastname: Brunialti
authors.affiliation: Hematology Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil.
authors.forename: Dayse M
authors.initials: DM
authors.lastname: Lourenço
authors.affiliation: Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo-UNIFESP, São Paulo, Brazil. Electronic address: frmachado@unifesp.br.
authors.forename: Flávia R
authors.initials: FR
authors.lastname: Machado
mesh_terms: D000368:Aged; D000465:Algorithms; D000991:Antithrombins / Q000032:analysis; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D001786:Blood Glucose / Q000032:analysis; D005167:Factor VII / Q000032:analysis; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis; D012772:Shock, Septic / Q000097:blood*; D010959:Tissue Plasminogen Activator / Q000097:blood
chemical_list: D000991:Antithrombins; D015415:Biomarkers; D001786:Blood Glucose; D017395:Plasminogen Activator Inhibitor 1; D011486:Protein C; D005167:Factor VII; D010959:Tissue Plasminogen Activator
keywords: Coagulation; Glycemic control; Hyperglycemia; Inflammation; Insulin; Septic shock