Direct effects of modest hyperglycaemia on susceptibility to infection in the critically ill patient
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* Corresponding author: Matt P Wise mattwise@doctors.org.uk
Adult Critical Care, University of Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
Critical Care 2008, 12:433 doi:10.1186/cc7089
Published: 5 November 2008First paragraph (this article has no abstract)
In their recent study, Otto and colleagues suggested that the adverse effects of hyperglycaemia on immune function may be mediated by hyperosmotic stress [1]. In granulocytes both oxidative burst and phagocytosis were suppressed by hyperosmolar stress with mannitol, but no significant effect was observed on cytokine release from peripheral blood mononuclear cells [1]. The concentration of glucose (and mannitol) used in these experiments (500 mg/dl or 27.8 mmol/l), however, is rarely encountered in critically ill patients – and then only transiently. One may question how relevant this mechanism is, when it appears that modest levels of hyperglycaemia (11.1 mmol/l) have deleterious effects in this population [2].