The Effect of Strict Blood Glucose Control on Biliary Sludge and Cholestasis in Critically Ill Patients
- 1 July 2009
- journal article
- research article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 94 (7), 2345-2352
- https://doi.org/10.1210/jc.2008-2579
Abstract
Cholestatic liver dysfunction and biliary sludge are common problems in critically ill patients. No specific strategies have been described to prevent cholestasis and biliary sludge in the intensive care unit (ICU). We examined liver dysfunction and biliary sludge prospectively in a large medical long-stay ICU population and hypothesized that tight glycemic control with intensive insulin therapy (IIT) reduces cholestasis and biliary sludge. This study was a preplanned subanalysis of 658 long-stay (at least a fifth day) ICU patients out of a large randomized controlled trial (n = 1200), studying the effects of IIT on the outcome of medical critical illness. Patients were allocated to either IIT (glycemia 80-110 mg/dl) or conventional insulin therapy (CIT) requiring insulin above a glycemia of 215 mg/dl. Different patterns of liver dysfunction were studied based on daily blood sample analysis, and biliary sludge was evaluated by ultrasonography. On admission, cholestasis was present in 17% of patients (n = 649), increasing to 20% on d 10 (n = 347), whereas ischemic hepatitis decreased from 3.4% (n = 588) to less than 1% (n = 328). IIT significantly decreased biliary sludge on d 5 (50.4 vs. 66.4%, P = 0.01; n = 250). The difference did not remain significant on d 10 (57.4 vs. 66.2%, P = 0.29; n = 136). IIT also lowered the cumulative risk of cholestasis (P = 0.03). Cholestatic liver dysfunction and biliary sludge are very common during prolonged critical illness but are significantly reduced by IIT.Keywords
This publication has 36 references indexed in Scilit:
- Mechanisms of Disease: update on the molecular etiology and fundamentals of parenteral nutrition associated cholestasisNature Clinical Practice Gastroenterology & Hepatology, 2007
- Incidence and prognosis of early hepatic dysfunction in critically ill patients—A prospective multicenter studyCritical Care Medicine, 2007
- Sepsis-induced cholestasisHepatology, 2006
- Cholestatic syndromesCurrent Opinion in Gastroenterology, 2002
- Prevalence and Significance of Gallbladder Abnormalities Seen on Sonography in Intensive Care Unit PatientsAmerican Journal of Roentgenology, 2000
- Biliary SludgeAnnals of Internal Medicine, 1999
- Gallbladder abnormalities in medical ICU patients: An ultrasonographic studyIntensive Care Medicine, 1996
- Gallbladder sludge: Spontaneous course and incidence of complications in patients without stonesHepatology, 1994
- Development of biliary sludge in patients on intensive care unit: results of a prospective ultrasonographic study.Gut, 1992
- Origin and fate of biliary sludgeGastroenterology, 1988