ADMISSION HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS WITH SEPSIS IN MEDICAL ICU; ROLE OF INSULIN RESISTANCE AND ITS RELATION TO OUTCOME

Abstract

Background: Hyperglycemia has long been recognized as a common occurrence in critically ill patient, even without history of diabetes mellitus (D.M). Objective: To investigate the role of insulin resistance in patients with sepsis admitted to medical intensive care unit (ICU) 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: 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+, creatinine, total leukocytic count (TLC), HB%, platelets (PLT), alanine transaminase (ALT), aspartate transaminase (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 C-reactive protein (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, mean arterial pressure (MAP) and heart rate (HR) compared to the control group. There was no significant difference between the 2 groups regarding temperature and RR. This study showed statistically significant decrease in mean values of Glasgow Coma Score (GCS) in hyperglycemic group compared to control group, while Acute Physiology and Chronic Health Evaluation II (APACHE II) and quick Sepsis Related Organ Failure Assessment (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 random blood sugar (RBS) and insulin resistance (IR) 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, acute kidney injury (AKI) and outcome, and non-significant difference according to Interstitial lung disease (ILD), chronic lung disease (CLD), chronic kidney disease CKD, stroke, pneumonia, Ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) and heart failure (HF). Conclusion: Stress hyperglycemia with high insulin resistance 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.