Abstract
Critically ill patients requiring prolonged intensive care are characterized by a profound decrease of lean body mass, evoking weakness and impairing rehabilitation, whereas, paradoxically, adipose tissue is preserved (1, 2). Remarkably, overweight (body mass index [BMI], 25–30 kg/m 2 ) and obese (BMI, 30–40 kg/m 2 ) critically ill patients have recently been shown to have a lower risk of death than patients with a normal BMI (3–5). Morbid obesity (BMI > 40 kg/m 2 ), however, is an independent risk factor for death in the intensive care unit (ICU) (4). These observations suggest that adipose tissue may play a protective role during severe illness in the intensive care setting. The primary metabolic role of adipose tissue is to store excess energy as triglycerides. This excess energy mainly originates from circulating lipids, which are taken up by adipocytes via action of lipoprotein lipase (LPL). A much smaller part of the stored triglycerides in adipocytes is de novo synthesized from circulating carbohydrates through lipogenesis (6). Critically ill patients suffer from dyslipidemia and hyperglycemia, partly due to increased hepatic lipogenesis (7) and gluconeogenesis (8). The severity of these alterations is associated with adverse outcome (9–11). Moreover, elevated circulating glucose (12–14) levels as well as high levels of triglycerides (15–17) can aggravate vital organ dysfunction during critical illness. We hypothesized that adipose tissue can respond to illness by increasing its storage properties for such circulating toxic metabolites, whereby it may enhance the chances of survival. To test this hypothesis, we obtained abdominal subcutaneous and omental adipose tissue biopsies from 61 nonsurviving critically ill patients with a BMI ranging from 16.3 to 31.2 kg/m 2 , and compared these with biopsies from 20 matched control subjects undergoing elective abdominal surgery. More specifically, we studied adipose tissue morphology as well as its ability to take up and metabolize glucose and triglycerides. In addition, we studied adipose tissue morphological changes in response to critical illness in in vivo subcutaneous limb adipose tissue from 27 critically ill patients, and in the controlled setting of an animal model. Some of the results of this study have been previously reported in the form of an abstract (18, 19).
Highlights
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function
The clinical use of EPO has been cautioned most recently due to serious safety concerns arising from an increased mortality in acute stroke patients treated with EPO and simultaneously receiving systemic thrombolysis [2]
In awake, spontaneously breathing mice, inhaling hydrogen sulfide (H2S) induced a hibernation-like metabolic state characterised by reduced energy expenditure and hypothermia [1], which protected against otherwise lethal hypoxia [2] and hemorrhage [3]
Summary
We previously showed that erythropoietin (EPO) attenuates the morphological signs of spinal cord ischemia/reperfusion (I/R) injury in swine [1] without, improving neurological function. Methods We studied 90 patients affected by severe sepsis or septic shock previously enrolled in a prospective trial regarding the impact of glycemic control on inflammation and coagulation. In a retrospective analysis of the data from the SBITS-trial [1] we investigated whether the initial level of serum IgG on admission to the hospital in patients with sepsis and septic shock (before the first administration of the first dose of intravenous immunoglobulins) could be seen as a prognostic parameter for the primary outcome, lethality on day 28, or the secondary endpoints, lethality on day 7 or on the ICU. The aim of this analysis was to assess the impact of real-time continuous glucose monitoring (CGM) on glucose variability in critically ill patients receiving intensive insulin therapy (IIT) Methods This is the post hoc analysis of a prospective, randomized, controlled trial [2]. Respecting anonymity we have statistically evaluated 103 replies (response rate was 13.8%) and compared with data from other European countries
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
