Intensive insulin therapy does not alter the inflammatory response in patients undergoing coronary artery bypass grafting: a randomized controlled trial ISRCTN95608630Report as inadecuate




Intensive insulin therapy does not alter the inflammatory response in patients undergoing coronary artery bypass grafting: a randomized controlled trial ISRCTN95608630 - Download this document for free, or read online. Document in PDF available to download.

Critical Care

, 9:R790

First Online: 16 November 2005Received: 26 August 2005Revised: 06 October 2005Accepted: 21 October 2005

Abstract

IntroductionStrict control of plasma glucose in diabetic and non-diabetic patients has been shown to improve outcome in several clinical settings. There is extensive evidence that glucose can stimulate the production of pro-inflammatory cytokines such as tumor necrosis factor TNF-α and IL-6, with no effect on the anti-inflammatory cytokine IL-10. We hypothesized that strict glucose regulation results in a change in cytokine balance from a pro-inflammatory state to a more balanced anti-inflammatory condition. In a randomized controlled trial we studied the effect of strict glycemic control on the local and systemic pro-inflammatory and anti-inflammatory balance in non-diabetic patients undergoing elective coronary artery bypass grafting with cardiopulmonary bypass.

MethodsAfter surgery patients were randomly assigned to intensive insulin therapy blood glucose between 80 and 110 mg-dl or conventional insulin therapy blood glucose less than 200 mg-dl. At 0, 1, 2, 4, 8, 12, 16 and 24 hours after admission to the intensive care unit, plasma samples and samples from the mediastinal drains were obtained. We measured the concentrations of the pro-inflammatory cytokines TNF-α and IL-6 and the anti-inflammatory cytokine IL-10 by enzyme-linked immunosorbent assay.

ResultsBoth patient groups were comparable in demographics, clinical characteristics and peri-operative data. In the intensive treatment group, glucose levels were significantly lower than in the conventionally treated group. No differences were found between both groups in the concentrations of TNF-α, IL-6 and IL-10 in plasma samples or in fluid draining the mediastinal cavity. Levels of IL-6 and IL-10 were significantly higher in mediastinal fluid samples than in plasma samples, suggesting a compartmentalized production of cytokines.

ConclusionThe protective effect of intensive insulin therapy in patients after cardiac surgery with cardiopulmonary bypass is not related to a change in cytokine balance from a pro-inflammatory to an anti-inflammatory pattern. Systemic cytokine levels are not representative of the local inflammatory response.

AbbreviationsCABGcoronary artery bypass grafting

ICUintensive care unit

ILinterleukin

NFnuclear factor

TNFtumor necrosis factor.

Electronic supplementary materialThe online version of this article doi:10.1186-cc3911 contains supplementary material, which is available to authorized users.

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Author: Cornelia W Hoedemaekers - Peter Pickkers - Mihai G Netea - Marcel van Deuren - Johannes G Van der Hoeven

Source: https://link.springer.com/







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