The clinical significance of acute insulin resistance during surgical sepsis / 解放军医学杂志

ABSTRACT

Objective To investigate the clinical significance of acute insulin resistance during surgical sepsis. Methods Forty surgical patients with sepsis in experimental group and twenty patients with similar APACHEⅡ but without sepsis in experimental control group were enrolled in our study. In the experimental group, the patients were categorized to sepsis group and septic shock and MODS(SM)group according to clinical manifestations, and were also grouped according to different causes of sepsis, i.e.severe acute pancreatitis(SAP)group, intestinal fistula group and other diseases group. Determinations of fasting blood glucose, fasting plasma insulin, clinical nutritional parameters, plasma TNF-α, APACHEⅡ, sepsis-related organ failure assessment(SOFA)and severe scores were simultaneously performed at designated time points. Insulin resistance index was calculated using homeostasis model assessment(HOMA)to assess insulin sensitivity of surgical patients with sepsis. Results (1)A significant elevation of lgHOMA-IR levels was found in 84% of tests in sepsis. Peak lgHOMA-IR values increased in all patients.(2)LgHOMA-IR was significantly higher in patients with sepsis than those without sepsis from the first 24 hours(1.22±0.23 vs 0.73±0.21, P＜0.01)to the 7th day(0.46±0.32 vs 0.30±0.13, P＜0.01).(3)There was no significant difference in lgHOMA-IR among SAP, intestinal fistula and other groups at different times(P＞0.05).(4)There was significant difference in lgHOMA-IR between sepsis group and SM group during the whole septic episode(P＜0.01).During the septic episode, there were significant correlation between lgHOMA-IR and APACHEⅡ(r=0.591, P＜0.01), lgHOMA-IR and SOFA(r=0.496, P＜0.01), lgHOMA-IR and SS(r=0.553, P＜0.01), and lgHOMA-IR and TNF-α(r=0.658, P＜0.01).(5)lgHOMA-IR was independently directly correlated with LDL, prealbumin, cholesterol and triglyceride. R2 of the equation was 0.188. Conclusion There usually is insulin resistance in surgical sepsis, regardless the primary diseases. Insulin resistance may simply be a marker reflecting an underlying physiological derangement, implying indicates higher mortality. Among several clinical nutrition parameters, LDL, prealbumin, cholesterol, and triglyceride showed closer relationship with insulin resistance in patients with sepsis.