Admission hyperglycemia and outcome in ICU patients with sepsis

Stress hyperglycemia is a very common feature in the intensive care (ICU) setting and it is related to multiple causes that include inflammatory and neuro-endocrine derangements in critically ill patients, which lead to insulin resistance and high hepatic glucose output (1). The target for glucose management in this population and its relationship with the patients’ outcome is not clear, and results from literature are contrasting. Some evidences state that hyperglycemia, with a threshold value of 180 mg/dL, relates to an increased risk of death and morbidity due to infection in ICU patients (2). The main multicentric studies assessing the role of glucose management in critically ill patients found inconclusive results and the doubt was cast upon the benefits of tight glycemic control. In particular, the NICE-SUGAR (Normoglycemia in Intensive Care Evaluation-Survival Using Glucose Algorithm Regulation) trial compared 2 groups of patients with glucose target of 4.5 to 6.0 mmol/L versus 8.0 to 10.0 mmol/L and reported an absolute increase in deaths at 90 days in patients with intensive insulin treatment, suggesting that there is no additional benefit from lowering blood glucose levels below a “moderate” target range (3). Over time, optimal blood glucose target range has dramatically changed; recent evidence demonstrates that a tailored blood glucose target range should be adopted in specific subgroups of patients and that even the timing and type of nutrition is associated with changes in outcome, suggesting that in critically ill patients, an accurate nutrition protocol as well as a strict control of the duration of insulin infusion is mandatory (4)