The roles of insulin and hyperglycemia in sepsis pathogenesis

Journal of Leukocyte Biology

Christian Christiansen¹  Else Tønnesen¹  Jakob Gjedsted¹  Soren Kaeseler Andersen¹ 

[1] Department of Anesthesiology and Intensive Care, Institute of Experimental Clinical Research. Aarhus University Hospital, Denmark Department of Anesthesiology and Intensive Care, Institute of Experimental Clinical Research. Aarhus University Hospital, Denmark Department of Anesthesiology and Intensive Care, Institute of Experimental Clinical Research. Aarhus University Hospital, Denmark

关键词: metabolism;    endocrinology;    stress hyperglycemia;    septic shock;    immunology;    inflammation;   

DOI  :  10.1189/jlb.0503195

学科分类：生理学

来源: Federation of American Societies for Experimental Biology

【 摘 要 】

Hyperglycemia is a risk marker of morbidity and mortality in acute critical illness, and insulin therapy seems to be beneficial in this patient group. Whether this is true for a population of sepsis patients, as such, has not been investigated in clinical trials, but evidence from in vitro studies and experimental sepsis suggests that this may be the case. The endocrinology of septic patients is characterized by a shift in the balance between insulin and its counter-regulatory hormones favoring the latter. This leads to prominent metabolic derangements composed of high release and low use of glucose, amino acids, and free fatty acids (FFA), resulting in increased blood levels of these substrates. Circulating, proinflammatory mediators further enhance this state of global catabolism. Increased levels of glucose and FFA have distinct effects on inflammatory signaling leading to additional release of proinflammatory mediators and endothelial and neutrophil dysfunction. Insulin has the inherent capability to counteract the metabolic changes observed in septic patients. Concomitantly, insulin therapy may act as a modulator of inflammatory pathways inhibiting the unspecific, inflammatory activation caused by metabolic substrates. Given these properties, insulin could conceivably be serving a dual purpose for the benefit of septic patients.

【 授权许可】

Unknown