Inflammation and Oxidative Stress in Cardiac Surgery Patients Treated to Intensive vs. Conservative Glucose Targets.

Inflammation and Oxidative Stress in Cardiac Surgery Patients Treated to Intensive vs. Conservative Glucose Targets.

J Clin Endocrinol Metab. 2016 Nov 14;:jc20163197

Authors: Reyes-Umpierrez D, Davis G, Cardona S, Pasquel FJ, Peng L, Jacobs S, Vellanki P, Fayfman M, Haw S, Halkos M, Guyton RA, Thourani VH, Umpierrez GE, Cde

Abstract
OBJECTIVE: We aimed to determine (a) longitudinal changes of inflammatory and oxidative stress markers and (b) the association between markers of inflammation and perioperative complications in coronary artery bypass surgery (CABG) patients treated with intensive vs. conservative blood glucose (BG) control.
METHODS: Patients with diabetes (n = 152) and without diabetes with hyperglycemia (n = 150) were randomized to intensive (n = 151, BG: 100-140 mg/dL) or to conservative (n = 151, BG: 141-180 mg/dL) glycemic targets. Plasma cortisol, high sensitivity C-reactive protein (hsCRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), thiobarbituric acid-reactive substances (TBARS) and 2'-7'-dichlorofluorescin (DCF) were measured prior to and at days 3, 5 and 30 after surgery.
RESULTS: Intensive glycemic control resulted in lower mean BG (132±14 mg/dL vs. 154±17 mg/dL, p<0.001) in the ICU. Cortisol and inflammatory markers increased significantly from baseline after the 3(rd) and 5(th) day of surgery (p<0.001), and returned to baseline levels at 1 month of follow-up. Patients with perioperative complications had higher levels of cortisol, hsCRP, IL-6 and oxidative stress markers compared to those without complications. There were no significant differences in inflammatory and oxidative stress markers between patients, with or without diabetes or complications, treated with intensive or conventional glucose targets.
CONCLUSION: We report no significant differences in circulating markers of acute inflammatory and oxidative stress response in cardiac surgery patients, with or without diabetes, treated with intensive (100-140 mg/dL) or conservative (141-180 mg/dL) insulin treatment.

PMID: 27841946 [PubMed - as supplied by publisher]

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