title: Insulin resistance and beta 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.
authors.affiliation: Department of Medicine, S.C.B. Medical College and Hospital, Cuttack, India. sidhartha_cuttack@yahoo.co.in
authors.forename: Sidhartha
authors.initials: S
authors.lastname: Das
authors.forename: Bijay
authors.initials: B
authors.lastname: Misra
authors.forename: Laxmidhar
authors.initials: L
authors.lastname: Roul
authors.forename: Noas Tobias
authors.initials: NT
authors.lastname: Minz
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Pattnaik
authors.forename: Mirza Asraf Ali
authors.initials: MA
authors.lastname: Baig
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D001639:Bicarbonates / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness; D018450:Disease Progression; D005260:Female; D006801:Humans; D007194:India; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance; D050417:Insulin-Secreting Cells / Q000378:metabolism*; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009102:Multiple Organ Failure / Q000097:blood / Q000401:mortality / Q000503:physiopathology*; D013997:Time Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D001639:Bicarbonates; D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D019344:Lactic Acid