HOMA-estimated insulin resistance as an independent prognostic factor in patients with acute pancreatitis

Abstract

This prospective study investigated the relationship between insulin resistance assessed using the homeostatic model assessment of insulin resistance (HOMA-IR) and the prognosis of acute pancreatitis (AP). A total of 269 patients with AP were recruited in this study. HOMA-IR scores were calculated using fasting insulin and plasma glucose levels. Patients were then categorized into the non-insulin-resistant group (HOMA-IR <2.5) and the insulin-resistant group (HOMA-IR ≥2.5). We performed multivariable logistic regression analysis to investigate the independent association between IR assessed using HOMA-IR and the severity of AP. We also conducted receiver operating characteristic analysis to investigate the predictive ability of HOMA-IR for severe AP. The proportion of patients with severe AP (according to the Atlanta classification) and the percentage of ICU admissions and mortality were higher in patients with insulin resistance than in those without insulin resistance. The area under the curve (AUC) of HOMA-IR for predicting severe AP was 0.719 (95% CI 0.59–0.85, P = 0.003). This value was not significantly different from the AUCs of other AP scoring systems such as CTSI, Ranson, and BISAP. Insulin resistance was the only independent factor for either ICU admission (OR 5.95, 95% CI 1.95–18.15, P = 0.002) or severe AP (OR 6.72, 95% CI 1.34–33.62, P = 0.020). Our findings suggest that the HOMA-IR score is an independent prognostic factor in patients with acute pancreatitis. This finding indicates that insulin resistance is potentially involved in the mechanism for severe AP.

Role of N-acetyl cysteine for the prevention of postendoscopic retrograde cholangio-pancreatography pancreatitis

“…Insulin resistance is the hallmark of DM. 25 Seung Kook Cho demonstrated that insulin resistance assessed using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was significantly associated with severity of pancreatitis and Intensive Care Unit admission. 25 Ali Riza Koksal et al found insulin levels were statistically significantly higher in patients who developed PEP than in the ones who did not.…”

“…25 Seung Kook Cho demonstrated that insulin resistance assessed using Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) was significantly associated with severity of pancreatitis and Intensive Care Unit admission. 25 Ali Riza Koksal et al found insulin levels were statistically significantly higher in patients who developed PEP than in the ones who did not. 26 This current study reveals, PEP is significantly more in people with DM getting insulin than in people without insulin (p value 0.046).…”

Children With Asparaginase-associated Pancreatitis Present Elevated Levels of Insulin, Total Cholesterol, and HOMA-IR Before Starting Acute Lymphoblastic Leukemia Treatment

“…Concluding that insulin resistance is potentially involved in the mechanism for severe AP. 12 Concerning these findings, it has been found that various pro-inflammatory factors or cytokines are activated due to insulin resistance, including nuclear factor-kB, 13 tumor necrosis factor-alpha, 14 amylin, 15 and interleukin-6, 16 and these pro-inflammatory factors may be responsible for the initiation and progression of pancreatitis.…”

Mechanisms of Post-Pancreatitis Diabetes Mellitus and Cystic Fibrosis-Related Diabetes: A Review of Preclinical Studies

“…Upregulation of IL-6 has been also shown in experimental models of AP where it is associated with enhanced local and systemic response. The association between IR and AP severity was investigated in a prospective clinical study, where IR was shown to be an independent factor in predicting AP severity (62). These data suggest that in addition to increasing the risk of diabetes development, IR also exacerbates the outcome of pancreatitis.…”