Insulin Resistance in Critically Injured Adults: Contribution of Pneumonia, Diabetes, Nutrition, and Acuity.
OBJECTIVE
Changes in insulin resistance (IR) cause stress-induced hyperglycemia after trauma, but the numerous factors involved in IR have not been delineated clearly. We hypothesized that a statistical model could help determine the relative contribution of different clinical co-variates to IR in critically injured patients.


METHODS
We retrospectively studied 726 critically injured patients managed with a computer-assisted glycemic protocol at an academic level I trauma center (639 ventilated controls without pneumonia (VWP) and 87 patients with ventilator-associated pneumonia (VAP). Linear regression using age, gender, body mass index (BMI), diabetes mellitus, pneumonia, and glycemic provision was used to estimate M, a marker of IR that incorporates both the serum blood glucose concentration (BG) and insulin dose.


RESULTS
Increasing M (p<0.001) was associated with age (1.62%; 95% confidence interval [CI] 1.27%-1.97% per decade), male gender (9.78%; 95% CI 8.28%-12.6%), BMI (4.32% [95% CI 4.02%-4.62%] per 5 points), diabetes mellitus (21.2%; 95% CI 19.2%-23.2%), pneumonia (10.9%; 95% CI 9.31%-12.6%), and glycemic provision (27.3% [95% CI 6.6%-28.1%] per 100 g of glucose). Total parenteral nutrition was associated with a decrease in M of 10.3%; 95% CI 8.52%-12.1%; p<0.001.


CONCLUSIONS
Clinical factors can be used to construct a model of IR. Prospective validation might enable early detection and treatment of infection or other conditions associated with increased IR.
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Kaushik
K
Mukherjee
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Kendell J
KJ
Sowards
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Steven E
SE
Brooks
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Patrick R
PR
Norris
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Judith M
JM
Jenkins
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Miya A
MA
Smith
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Paul M
PM
Bonney
2 Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center , Nashville, Tennessee.
Jeffrey B
JB
Boord
1 Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center , Nashville, Tennessee.
Addison K
AK
May
D000328:Adult; D000818:Animals; D016638:Critical Illness; D005260:Female; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000150:complications* / Q000473:pathology*; D012189:Retrospective Studies; D014947:Wounds and Injuries / Q000150:complications* / Q000473:pathology*