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The effect of strict blood glucose control on biliary sludge and cholestasis in critically ill patients.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2009 Jul; Vol. 94 (7), pp. 2345-52. Date of Electronic Publication: 2009 Apr 14. - Publication Year :
- 2009
-
Abstract
- Background and Aims: Cholestatic liver dysfunction and biliary sludge are common problems in critically ill patients. No specific strategies have been described to prevent cholestasis and biliary sludge in the intensive care unit (ICU). We examined liver dysfunction and biliary sludge prospectively in a large medical long-stay ICU population and hypothesized that tight glycemic control with intensive insulin therapy (IIT) reduces cholestasis and biliary sludge.<br />Methods: This study was a preplanned subanalysis of 658 long-stay (at least a fifth day) ICU patients out of a large randomized controlled trial (n = 1200), studying the effects of IIT on the outcome of medical critical illness. Patients were allocated to either IIT (glycemia 80-110 mg/dl) or conventional insulin therapy (CIT) requiring insulin above a glycemia of 215 mg/dl. Different patterns of liver dysfunction were studied based on daily blood sample analysis, and biliary sludge was evaluated by ultrasonography.<br />Results: On admission, cholestasis was present in 17% of patients (n = 649), increasing to 20% on d 10 (n = 347), whereas ischemic hepatitis decreased from 3.4% (n = 588) to less than 1% (n = 328). IIT significantly decreased biliary sludge on d 5 (50.4 vs. 66.4%, P = 0.01; n = 250). The difference did not remain significant on d 10 (57.4 vs. 66.2%, P = 0.29; n = 136). IIT also lowered the cumulative risk of cholestasis (P = 0.03).<br />Conclusions: Cholestatic liver dysfunction and biliary sludge are very common during prolonged critical illness but are significantly reduced by IIT.
- Subjects :
- Aged
Algorithms
Bile metabolism
Blood Glucose metabolism
Cholestasis epidemiology
Cholestasis etiology
Cholestasis metabolism
Critical Illness mortality
Dose-Response Relationship, Drug
Female
Humans
Hypoglycemic Agents therapeutic use
Intensive Care Units
Liver Diseases epidemiology
Liver Diseases prevention & control
Male
Middle Aged
Prevalence
Risk Factors
Bile drug effects
Blood Glucose drug effects
Cholestasis prevention & control
Critical Illness therapy
Insulin therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 94
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 19366849
- Full Text :
- https://doi.org/10.1210/jc.2008-2579