PLoS ONE (Jan 2021)

Association of the systemic host immune response with acute hyperglycemia in mechanically ventilated septic patients.

  • Nauman Farooq,
  • Byron Chuan,
  • Hussain Mahmud,
  • Samar R El Khoudary,
  • Seyed Mehdi Nouraie,
  • John Evankovich,
  • Libing Yang,
  • Daniel Dunlap,
  • William Bain,
  • Georgios Kitsios,
  • Yingze Zhang,
  • Christopher P O'Donnell,
  • Bryan J McVerry,
  • Faraaz Ali Shah

DOI
https://doi.org/10.1371/journal.pone.0248853
Journal volume & issue
Vol. 16, no. 3
p. e0248853

Abstract

Read online

Hyperglycemia during sepsis is associated with increased organ dysfunction and higher mortality. The role of the host immune response in development of hyperglycemia during sepsis remains unclear. We performed a retrospective analysis of critically ill adult septic patients requiring mechanical ventilation (n = 153) to study the relationship between hyperglycemia and ten markers of the host injury and immune response measured on the first day of ICU admission (baseline). We determined associations between each biomarker and: (1) glucose, insulin, and c-peptide levels at the time of biomarker collection by Pearson correlation; (2) average glucose and glycemic variability in the first two days of ICU admission by linear regression; and (3) occurrence of hyperglycemia (blood glucose>180mg/dL) by logistic regression. Results were adjusted for age, pre-existing diabetes mellitus, severity of illness, and total insulin and glucocorticoid dose. Baseline plasma levels of ST2 and procalcitonin were positively correlated with average blood glucose and glycemic variability in the first two days of ICU admission in unadjusted and adjusted analyses. Additionally, higher baseline ST2, IL-1ra, procalcitonin, and pentraxin-3 levels were associated with increased risk of hyperglycemia. Our results suggest associations between the host immune response and hyperglycemia in critically ill septic patients particularly implicating the interleukin-1 axis (IL-1ra), the interleukin-33 axis (ST2), and the host response to bacterial infections (procalcitonin, pentraxin-3).