ADMISSION HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS WITH SEPSIS; HIGH IL6 AND ITS RELATION WITH OUTCOME

Abstract

Background: Hyperglycemia has long been recognized as a common occurrence in critically ill patient, even without history of diabetes mellitus (D.M). Although there are few studies investigating the prevalence of stress hyperglycemia, one study reported that 38% of patients admitted to general hospitals had hyperglycemia episodes, 16% of which had no previous history of D.M. Objective: To investigate the role of high IL6 in patients with sepsis admitted to medical I.C.U with acute hyperglycemia and its relation to 30 days outcome. Patients and Methods: This study was conducted on 100 adult septic patients who were admitted to medical I.C.U at Al-Hussein University Hospital, the study was carried in the period between January 2018 and June 2019. 80 patients with evidence of hyperglycemia and 20 patients with euglycemic state. Results: non-significant difference was found according to mean values of Na+, K+, creat, TLC, HB%, PLT, ALT, AST. On the other hand, the hyperglycemic group showed a significant increase regarding mean value of HbA1c compared to control group. The comparative study between the 2 groups revealed a significant increase of mean value of CRP in the hyperglycemic group compared to the control group. As regards the vital signs, the hyperglycemic group showed a significant increase in mean values of systolic blood pressure, diastolic blood pressure, MAP & HR compared to the control group. While there was no significant difference between the 2 groups regarding temperature and RR. This study showed statistically significant decrease in mean values of GCS in hyperglycemic group compared to control group, while APACHE II and qSOFA showed a significant increase in hyperglycemic group compared to control group. The mean values of ABG parameters revealed no statistically significant difference between the 2 groups. On the other hand, mean values of RBS and IL6 showed a statistically significant increase in hyperglycemic group compared to control group. The comparative study between the 2 groups showed a significant increase in mean values of hyperglycemic group compared to control group according to duration of ICU stay (days), Insulin therapy, AKI and Outcome and non-significant difference according to ILD, CLD, CKD, stroke, pneumonia, IHD, COPD & HF. Conclusion: Stress hyperglycemia with high IL6 is strongly associated with adverse outcomes in patients with sepsis who were admitted to the medical ICU. Sepsis patients with hyperglycemia showed increased incidence of mortality and AKI.