The clinical study of intensive insulin therapy of severe sepsis

YE Zhen-hai; GUI Jing-min; YOU Lei-ming; ZHANG Xuan-shun; LU Jie

doi:10.3760/cma.j.issn.1673-4777.2011.10.027

Abstract：Objective To investigate the effect of intensive insulin therapy on severe sepsis. Methods In a prospective,randomized controlled study, adult patients who were considered to need intensive care for at least three days were enrolled. On admission, one hundred and forty-two severe sepsis patients with hyperglycemia were randomly dividided into intensive insulin therapy group ( maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L) or conventional therapy group ( infusion tapered when the level of glucose at a level between 10.0 and 11.1 mmol/L). Mortality in the ICU, mortality in the hospital, days weaning from mechanical ventilation, days in the ICU and in the hospital, new kidney injury and new hepatic injury during intensive care were observed. Results The days in the ICU (12 ±3 days vs 15 ±4 days) ,in the hospital ( 19 ±6 days vs 24 ±7 days) and the days weaning from mechanical ventilation (10 ± 2 days vs 14 ± 3 days) in intensive insulin therapy group were significantly reduced than those in the conventional therapy group (P ＜ 0.01 ). The mortality in the ICU (22.5％ in the intensive insulin therapy group vs 42.3％ in the conventional therapy group, P ＜0.05 ) and in the hospital (36.6％ vs 54.9％, P ＜0.05 ) were also significantly reduced. Morever,morbidity was significantly reduced by the prevention of newly acquired kidney injury (8.5％ vs 19.7％, P ＜ 0.05). Conclusion Glucose levels in severe sepsis patients should be controlled through implementation of intensive insulin therapy to achieve normoglycemia, regardless of a history of diabetes.