Insulin Resistance and β Cell Function As Prognostic Indicator in Multi-Organ Dysfunction Syndrome

Abstract

Insulin resistance (IR) is a major factor in the pathogenesis of sepsis. Critically ill patients with multi-organ dysfunction syndrome (MODS), diagnosed as per modified Acute Physiology and Chronic Health Evaluation II (modified APACHE II) score criteria and admitted to the medical ward in our hospital, were assessed for IR and beta cell function by using the homeostasis model assessment A (HOMA-A) and HOMA-B models, respectively. Of 80 consecutive patients, 60 were followed up to day 7; 16 patients died and 4 did not agree to follow up. The mean value of IR in all the 80 patients studied on the day 1 of hospitalization was 6.67 +/- 10.65. The initial high values of serum insulin and IR were significantly reduced (p < 0.05) as these patients recovered from their critical illness. Of those who died, the first day mean insulin levels were high (13.80 +/- 14.72 micro/ml as well as IR 5.14 +/- 6.76 values), but they had statistically low beta cell function (46.45 +/- 433.64%) as compared to those who recovered (227.60 +/- 430.36%; p < 0.05). This suggests that, beta cell overexhaustion occurs in critically ill patients, because it was required to overcome the prevailing state of IR and has more bearing in patients having less than 4 organ failures. beta cell failure ensued from the onset in those who were more moribund and had more than four organs failing or those who died. IR and beta cell function are reliable indicators of the state of severity of critical illness, and they corroborated with mortality in patients with MODS.

Insulin, Glucagon, and Leptin in Critically Ill Foals

“…Ultimately, when the liver cannot maintain glucose production from fatty acids, blood triglyceride concentrations increase. Similarly, hypertriglyceridemia is the main feature of altered fat metabolism in critically ill humans 23 . In calves, glucose concentrations decrease and triglyceride concentrations increase in response to administration of endotoxin or TNF‐α 58 .…”

“…Insulin also has anti‐inflammatory properties by decreasing inflammatory cytokines and enhancing anti‐inflammatory mediators, 18 which may confer some therapeutic benefit in patients in a proinflammatory state (eg, septicemia or endotoxemia). Insulin resistance is a common feature of sepsis and endotoxemia in humans 21,23 and also has been reported in horses 24,25 …”

Single Gene Inactivation with Implications to Diabetes and Multiple Organ Dysfunction Syndrome

“…Insulin resistance and beta cell dysfunction has been associated with the development of MODS [79,80]. In Type 2 diabetes more than 150 genetic loci are associated with the development of diabetes and 50 candidate genes have shown to play a major part in the development of the disease [81].…”

The Role of Insulin Resistance in Outcome of Patients with Multi Organ Dysfunction Syndrome

“…Previous studies also showed the FBS, FIL and HOMA IR values were increased in cases with sepsis and MODS than in controls. 6,7 In our study it was observed that insulin resistance was significantly higher (64.5%) among non survivors than survivors (13.6 %) showing that patients with insulin resistance had increased risk of mortality. The values between the groups was statistically significant with chi-Square value 20.79 and p=0.000.…”