Relationship Between Hyperglycemia and Infection in Critically Ill Patients

Abstract

Hyperglycemia is a common problem encountered in hospitalized patients, especially in critically ill patients and those with diabetes mellitus. Uncontrolled hyperglycemia may be associated with complications such as fluid and electrolyte disturbances and increased infection risk. Studies have demonstrated impairment of host defenses, including decreased polymorphonuclear leukocyte mobilization, chemotaxis, and phagocytic activity related to hyperglycemia. Until 2001, hyperglycemia (blood glucose concentrations up to 220 mg/dl) had been tolerated in critically ill patients not only because high blood glucose concentrations were believed to be a normal physiologic reaction in stressed patients and excess glucose is necessary to support the energy needs of glucose-dependent organs, but also because the true significance of short-term hyperglycemia was not known. Recent clinical data show that the use of intensive insulin therapy to maintain tight blood glucose concentrations between 80 and 110 mg/dl decreases morbidity and mortality in critically ill surgical patients. Intensive insulin therapy minimizes derangements in normal host defense mechanisms and modulates release of inflammatory mediators. The principal benefit of intensive insulin therapy is a decrease in infection-related complications and mortality. Further research will define which patient populations will benefit most from intensive insulin therapy and firmly establish the blood glucose concentration at which benefits will be realized.

The role of TNF-α in chronic inflammatory conditions, intermediary metabolism, and cardiovascular risk

“…The increase in serum triglycerides (TGs) and glucose during acute inflammatory conditions may also provide extra nutrients for the increased metabolic needs of cells involved in host defense and tissue repair. In contrast, hyperglycemia, even acutely, has been extensively demonstrated to be associated with an impairment of host defense, including decreased polymorphonuclear mobilization, chemotaxis, and phagocytic activity (5).…”

“…Evidence of a link between inflammation and lipid metabolism was provided by studies showing dyslipidemia and insulin resistance during acute inflammation, as occurs in septic shock or trauma (2)(3)(4)(5). In turn, hyperlipidemia was shown to inhibit the acute inflammatory response (6).…”

Glycemic control in the infectious diseases ward; role of clinical pharmacist interventions

“…The presence of hyperglycemia has been demonstrated to be associated with an increased risk of infection in critically as well as non-critically ill patients [2,4]. This might be the result of suppressing immune functions by hyperglycemia secondary to impaired phagocytosis, diminished production of oxygen radicals from neutrophils, and chemotaxis [12]. On the other hand, infection as a prominent stress condition has been known to be associated with hyperglycemia through increased level of counter-regulatory hormones (e.g.…”

Impact of Admission Hyperglycemia on Stroke-Associated Pneumoniain Acute Cerebral Hemorrhage: A Retrospective Observational Study

“…The presence of hyperglycemia has been demonstrated to be associated with an increased risk of infection in acute stroke [6] [7]. This might be the result of suppressing immune functions by hyperglycemia secondary to impaired phagocytosis, diminished production of oxygen radicals from neutrophils, and chemotaxis [25]. On the other hand, infection as a prominent stress condition has been known to be associated with hyperglycemia through increased level of counter-regulatory hormones (e.g.…”