Prognostic significance of glucose fluctuation and inflammatory factors in critically ill patients

Objective To investigate the relationship among mean amplitude of glycemic excursions(MAGE), inflammatory factors (C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-b)) and prognosis in critically ill patients in Intensive Care Unit (ICU). Methods The study included 60 subjects(38 male subjects and 22 female subjects, mean age was 55 years, 2 subjects withdrew) , and they were admitted to ICU between January 2010 and January 2011, with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores over 10, stress hyperglycemia, non-diabetic history and glycated hemoglobin(HbA1c) between 4% and 6%. The subjects were taken monitor MAGE by continuous glucose monitoring system (CGMS) for 12 hours after admission, and measured serum levels of CRP, TNF-α and IL-6, and the prognosis was observed 28 days later. Analyze the relationship among MAGE, inflammatory factors and APACHE Ⅱ scores.The data was compared between the two groups by using t test. Results Pearson correlation analysis showed that 24 hours after admission MAGE correlated closely with CRP, TNF-α, IL-6 and APACHE Ⅱ (r=0.622, 0.505, 0.509, 0.597; P<0.01). Multivariate linear regression analysis suggested MAGE and IL-6 played more important roles in APACHE Ⅱ scores (P<0.05). Compared with survivors, subjects who died at the end of our study had much higher levels of MAGE and APACHE Ⅱ (P<0.01). Logistic regression analysis indicated that MAGE correlated with patients' motality (OR=4.401, 95%CI: 2.185-6.618, P<0.05). Conclusions MAGE is closely associated with serum inflammatory factors and critically ill patients' condition; (2)MAGE was an independent predictor in the prognosis of patients in ICU. Key words: Intensive care; Glycemic excursions; Inflammation mediators; Prognosis