Dyslipidemia: a prospective controlled randomized trial of intensive glycemic control in sepsis

Autor(es)

Cappi, Sylas B. ^[1] ; Noritomi, Danilo T. ^[1] ; Velasco, Irineu T. ^[1] ; Curi, Rui ^[2] ; Loureiro, Tatiana C. A. ^[2] ; Soriano, Francisco G. ^{[1, 3]}

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Lab Disciplina Emergencias Clin, BR-01246913 Sao Paulo - Brazil

^[2] Univ Sao Paulo, Inst Biomed Sci, BR-01246913 Sao Paulo - Brazil

^[3] Univ Sao Paulo, Univ Hosp, Intens Care Unit, BR-01246913 Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: Intensive Care Medicine; v. 38, n. 4, p. 634-641, APR 2012.
• Citações Web of Science: 17

Resumo

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. 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 low-density lipoprotein, high-density lipoprotein, triglycerides, total cholesterol, free fatty acids, and oxidized low-density lipoprotein were determined. 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 low-density 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. Free fatty acids respond to intensive glycemic control and, because of their high toxicity, can be a therapeutic target in patients with sepsis. (AU)

• Processo FAPESP: 04/02161-2 - Estudo das alterações metabólicas, da variabilidade de frequência cardíaca e troponina no paciente séptico: análise da participação da resistência insulínica nas alterações metabólicas e disfunção cardíaca na sepse
• Beneficiário: Francisco Garcia Soriano
• Modalidade de apoio: Auxílio à Pesquisa - Regular