Objectives: To estimate the at admission levels of random blood glucose (RBG), interleukin-6 (IL-6) andtumor necrosis factor-α (TNF-α) and their correlation to survival of patients admitted to surgical ICU. Patients &Methods: All adults patients admitted to surgical ICU for postoperative care and mechanical ventilation were enrolled in the study. All patients were clinically evaluated as regards illness severity using the Acute Physiology and Chronic Health Evaluation (APACHE II) and the simplified Therapeutic Intervention Scoring System (TISS-28) and blood samples were obtained for estimation of RBG and serum IL-6 and TNF-α levels. Patients were categorized according to at admission RBG level into normoglycemic or hyperglycemic (RBG >140mg/dl). Results: The study included 123 patients admitted to ICU and receiving mechanical ventilation; 27 patients were diabetics, 29 patients were hyperglycemic non-diabetics and 67 patients were normoglycemic. Twenty-eight patients died (22.8%), 10 normoglycemic (14.9%), 10 diabetics (37%) and 8 hyperglycemic non-diabetic (27.6%) patients. Estimated at ICU admission serum levels of IL-6 and TNF-α were significantly higher in hyperglycemic compared to normoglycemic patients and in diabetic compared to non-diabetic hyperglycemic patients. Estimated at ICU admission RBG and serum levels of IL-6 and TNF-α were significantly higher in non-survivors compared to survivors and in non-survivors hyperglycemic patients compared to non-survivors normoglycemic patients with non-significantly higher levels in diabetics compared non-diabetics. There was a positive significant correlation between levels of RBG and serum IL-6 and TNF-α. Levels of RBG and serum IL-6 showed a negative significant correlation with survival. Regression analysis defined at admission RBG level and serum level of IL-6 as bad predictors for survival. Conclusion: Elevated RBG levels at time of ICU admission is a frequent event accounting for about 30% and is associated with elevation of serum pro-inflammatory cytokines and may be a predisposing factor for development of additional morbidities and mortalities in non-diabetic postoperative critically ill mechanically ventilated patients. |
