Hyperglycaemic Emergencies are Associated with Increased Pro-inflammatory Cytokine (Interleukin-6) and Cortisol

Cortisol, a counter-regulatory hormone, has been implicated in the pathogenesis of metabolic disturbance in patients with diabetes, and high levels of cortisol have been reported in relation to blood glucose. Elevated blood glucose has been shown to stimulate production of pro-inflammatory cytokines such as interleukin-6 (IL-6).

We set out to investigate pro-inflammatory cytokine (Interleukin-6 [IL-6]) and counter-regulatory hormone (cortisol) and their relationship with outcome in patients with HE in a Nigerian hospital.

This descriptive, cross-sectional study involved 67 patients with HE and 67 age-, sex-, and body mass index (BMI)-matched diabetic patients without HE who served as controls. Clinical findings and laboratory parameters including IL-6 and cortisol were compared between subjects and controls.

Mean serum cortisol and interleukin-6 were significantly higher in HE subjects compared with diabetic non-HE controls (26.9 ±13.1 vs 9.4 ± 1.8µg/dl, 24.0 ± 8.5 vs 8.1 ± 4.1pg/ml, respectively). There was a significant drop in the values of cortisol and IL-6 at resolution of HE. Mean cortisol and IL-6 were significantly higher in HE patients with a fatal outcome compared with HE survivors (46.9±5.6 vs 25.3±12.1 µg/dl, 45.2±2.2 vs 22.3±6.2 pg/ml, respectively). Serum Cortisol correlated positively with total insulin dose required to resolve HE.

Hyperglycaemia in Nigerians with HE is associated with more profound inflammatory response characterized by higher interleukin-6 and cortisol and a worse outcome compared with levels at resolution of HE and in non-HE diabetic controls. Perhaps, treatment targeting this heightened response may be beneficial to the management of HE.