Yoğun Bakımda İzlenen Hastalarda Krom Seviyesinin Glukoz Metabolizmasına, Lipid Metabolizmasına, Morbidite ve Mortalite Oranlarına Olan Etkilerinin İncelenmesi

Abstract

Chromium (Cr) is known to be a trace element that facilitates carbohydrate and lipid metabolism. Current studies discuss that chromium deficiency may lead to increased blood glucose, total cholesterol, and triglyceride levels; decreased HDL levels and insulin sensitivity; and may thus be associated with certain conditions such as cardiovascular diseases and type 2 diabetes. In our study, we aimed to provide a novel perspective to the literature by determining the relationship between blood chromium levels and critical illness hyperglycemia and dyslipidemia in patients followed up in the intensive care unit (ICU). By addressing this relationship, we aimed to contribute to reducing some potential future complications in this critically ill population and, consequently, morbidity and mortality rates. After obtaining ethical committee approval, patients admitted to Hacettepe University Anesthesiology ICU between February 7, 2024, and August 8, 2024, were included in the study. Blood samples taken on the day of admission were analyzed for HbA1c, lipid panel, and blood chromium levels. Prospective measurements of weekly lipid panel, blood chromium levels; and daily blood glucose readings were recorded during the patients’ stay. Demographic information, comorbidities, reasons for ICU admission, APACHE – II and SOFA scores, length of stay (ICU and hospital), and nutritional status of the patients were also examined. Additionally, glycemic variabilities (GV) of all patients were calculated using coefficients of variation (CV). A CV of ≥ 36% was considered abnormal. Plasma chromium levels were measured using inductively coupled plasma mass spectrometry (ICP – MS), with a normal plasma range defined as 0.7 – 28.0 µg/L. Mann–Whitney U and Spearman’s Rho tests were applied to non – normally distributed data. Associations between variables and outcomes were evaluated using Chi – square tests with Bonferroni correction for multiple comparisons. The study included 309 patients [167 (54%) female and 142 (46%) male] with a median (range) age of 63.72 (19 – 99) years. Based on the obtained data, no statistically significant relationship was found between plasma chromium levels and glucose and lipid metabolism. However, a significant association was observed between plasma chromium levels measured on the 7th day of ICU admission (second measurement) and mortality. Furthermore; male gender, admission due to respiratory distress or sepsis compared to postoperative monitoring, increased SOFA and APACHE – II scores, higher glycemic variability, elevated triglyceride and VLDL levels; lower HDL, LDL and total cholesterol levels were found to significantly increase mortality. It was also determined that mortality rates were significantly lower in patients fed via the enteral route. In conclusion, based on data suggesting that chromium deficiency is associated with hyperglycemia, dyslipidemia, increased mortality, and prolonged hospital stay, this study aimed to provide a new perspective to the existing literature regarding reducing morbidity and mortality rates according to chromium levels in critical care settings. Although plasma chromium levels measured on the 7th day of ICU admission (second measurement) were significantly associated with mortality, our study did not find a direct effect of chromium levels on glucose and lipid metabolism in ICU patients.