Stężenie glukozy we krwi chorych z ciężkš sepsš i wstrzšsem septycznym

*Barbara Barteczko, Agnieszka Zamirowska, Andrzej Kübler

Summary
Background.Hyperglycemia is a common finding in septic shock, and is associated with an increased morbidity. Strict glucose control in ITU patients has been recommended by several authors. The latest consensus conference recommended that glucose concentration in these patients should be kept within the normal range, and if possible, below 8.3 mmol l ^-1. Since an objective measure of hyperglycemia for assessing glucose control in acutely ill patients should reflect the magnitude and duration of hyperglycemia, the hyperglycemic index (HGI) was proposed, defined as the area under the curve above the upper limit of normal glucose level (6.0 mmol l ^-1), divided by the total length of stay.
Methods. This retrospective study included all patients with severe sepsis and septic shock, admitted to the ITU. Admission type, sex, age, APACHE II score and outcome were recorded. HGI, serum glucose (at admission, mean, maximal and minimal concentrations), and insulin requirement were noted for each patient.
Results. Sixty five septic shock patients (61% males, 39% females), aged 19-96 (mean 62) years, were enrolled in the study. The mortality rate was 62%. Median HGI was 2.75 mmol l ^-1 in survivors versus 3.94 mmol l ^-1 in non-survivors (p<0.05). Median daily insulin requirement was 50 IU in survivors, vs. 38 IU in non-survivors (p<0.05).
Conclusion. We conclude that HGI is a useful index of severity in septic shock. The highest mortality rate was associated with an increased HGI which may indicate inadequate control of serum glucose concentration in septic patients.

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