Glycemic control and changes of inflammatory factors in severe sepsis patients and their clinical significance

Objective To investigate glycemic control, changes of inflammatory factors and their clinical significance in severe sepsis patients. Methods One hundred and three severe sepsis patients with abnormal hyperglycemia were randomly divided into the two groups and receive intensive insulin therapy (IIT) and conventional insulin therapy (CIT) respectively. According to glycosylated hemoglobin level, the two groups were further divided into stress hyperglycaemia and diabetes mellitus subgroups. The mortality and incidence of hypoglycemia were compared between the groups and subgroups. Enzyme linked immunosorbent assay was used to detect TNF-α, IL-6 levels before treatment, 3 and 7 days after treatment. Results In IIT group, the mortality in diabetes mellitus subgroup was significantly higher than that in stress hyperglycaemia subgroup (66.7% vs. 30.8%, P<0.05), while the mortality in stress hyperglycaemia subgroup significantly higher than that in diabetes mellitus subgroup (54.1% vs. 25.0%, P<0.05) in CIT group. Multivariate Logistic regression analysis revealed IIT increased the risk for death in diabetes mellitus subgroup(OR=1.221, 95%CI: 1.075-1.434), while decreased the risk for death in stress hyperglycaemia subgroup(OR=0.872, 95%CI: 0.714-0.975). The incidence of hypoglycemia was significantly higher in IIT group than that in CIT group(13.7% vs. 1.9%, P<0.05). Before treatment, the levels of TNF-α, IL-6 in stress hyperglycaemia patients were significantly higher than those in diabetes mellitus patients. After 7 day treatment, The levels of TNF-α, IL-6 decreased significantly in stress hyperglycaemia patients (P<0.01), and decreased more significantly in IIT group than that in CIT group. Conclusion Severe sepsis patients with stress hyperglycaemia can attain better glycemia control and inhibition of inflammatory factors, and clinical benefit from IIT. Key words: Severe sepsis; Stress hyperglycemia; Type 2 diabetes melittus; Intensive insulin therapy; Conventional insulin therapy; Inflammatory factors; Glycosylated hemoglobin; Prognosis