title: Insulin resistance in critically ill patients with acute renal failure.
abstract: Mortality in critically ill patients with acute renal failure (ARF) remains high. Hyperglycemia associated with insulin resistance has been associated with adverse outcomes in critically ill intensive care unit (ICU) patients but has not been examined specifically in patients with ARF. We used data from a subcohort (n = 90) of the Program to Improve Care in Acute Renal Disease (PICARD), an observational study of 618 adult ICU patients with ARF in whom nephrology service consultation was obtained. We obtained simultaneous measurements of serum glucose, insulin, insulin-like growth factor (IGF)-I, and IGF-1 binding proteins (IGFBP) in 90 patients. Daily glucose determinations were obtained from a larger fraction of the PICARD cohort (n = 509). Among the 90 patients with intensive metabolic monitoring, glucose concentrations in survivors were significantly lower than in nonsurvivors throughout the 5-wk period (P = 0.008, adjusted P = 0.013). In the larger PICARD cohort (n = 509), hyperglycemia was also significantly associated with in-hospital mortality. Mean insulin concentrations were significantly higher (431 +/- 508 vs. 234 +/- 189 pmol/l, P = 0.03), mean homeostasis model of insulin resistance levels were significantly higher (24.1 +/- 30.0 vs. 11.7 +/- 12.5, P = 0.04), and IGFBP-3 concentrations were significantly lower (1,190 +/- 498 vs. 1,470 +/- 581 microg/l, P = 0.02) among nonsurvivors compared with survivors. Insulin resistance as defined by hyperglycemia in the setting of higher insulin concentrations may be associated with mortality in critically ill patients with ARF. The IGF-IGFBP axis may play an important role in this process.
authors.affiliation: Department of Medicine, Division of Nephrology, Vanderbilt University Medical Center, Nashville, TN 37232-2372, USA.
authors.forename: Seema
authors.initials: S
authors.lastname: Basi
authors.forename: Lara B
authors.initials: LB
authors.lastname: Pupim
authors.forename: Edith M
authors.initials: EM
authors.lastname: Simmons
authors.forename: M Tugrul
authors.initials: MT
authors.lastname: Sezer
authors.forename: Yu
authors.initials: Y
authors.lastname: Shyr
authors.forename: Stephanie
authors.initials: S
authors.lastname: Freedman
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Emil
authors.initials: E
authors.lastname: Paganini
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.forename: T Alp
authors.initials: TA
authors.lastname: Ikizler
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology; D006946:Hyperinsulinism / Q000097:blood / Q000453:epidemiology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D018970:Insulin-Like Growth Factor Binding Protein 1 / Q000097:blood; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015398:Signal Transduction / Q000502:physiology; D013002:Somatomedins / Q000502:physiology; D017741:Survivors
chemical_list: D001786:Blood Glucose; D007328:Insulin; D018970:Insulin-Like Growth Factor Binding Protein 1; D018972:Insulin-Like Growth Factor Binding Protein 3; D013002:Somatomedins