Relación de la hiperglucemia con la producción de especies reactivas de oxígeno en pacientes críticamente enfermos y su influencia en la evolución clínica

Abstract

A common feature observed in patients admitted to the Intensive Care Unit (ICU) is the presence of hyperglycemia in the absence of prior history of diabetes. This rise in glucose concentration is known as stress hyperglycemia, and is considered as a negative factor for the evolution of patients in the ICU. Therefore, we conducted a prospective longitudinal study. We enrolled patients hospitalized in the ICU with pneumonia as diagnosis at INER. We extracted 3 blood samples starting at 24, 48 and 72 hours after admission. Samples were processed by flow cytometry to determine the production of reactive oxygen species (ROS), and patients were followed through their clinical data. Our results showed that 87% of patients admitted to ICU admission had a diagnosis of community-acquired pneumonia (CAP). After admission all patients progressed to sepsis, and hyperglycemia. The highest concentrations of glucose were observed in patients who died (147mg/dl) compared with patients who survived (129 mg / dl) (p <0.001). Additionally, we found that the total percentage of lymphocytes was lower in the group of patients who died (5.7 vs 11.8%, p <0.001). We also found significant differences in ROS production in patients surviving against the deceased, being significantly higher in this population. Our results showed that patients in the ICU of INER, CAP was associated with hyperglycemia, lymphopenia and neutrophilia in both cases, and an increase in the production of ROS, with 3 days of our observation period. This suggests the importance of continually assessing glucose, neutrophils and lymphocytes in ICU patients with a primary diagnosis of CAP, as the glucose rise may be causing an increase in free radical production and that directly influence a poor prognosis for ICU patients.