Advertisment Polium-B
Indian Journal of Critical Care Medicine
An open access publication of ISCCM™ 
 
Users online: 356 
     Home | Login 
  About Current Issue Archive Search Instructions Online Submission Subscribe Etcetera Contact  
  Navigate Here 
 »   Next article
 »   Previous article
 »   Table of Contents

 Resource Links
 »   Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
 »   Citation Manager
 »   Access Statistics
 »   Reader Comments
 »   Email Alert *
 »   Add to My List *
 * Requires registration (Free)
 

 Article Access Statistics
    Viewed552    
    Printed12    
    Emailed0    
    PDF Downloaded146    
    Comments [Add]    

Recommend this journal

 

 RESEARCH ARTICLE
Year : 2018  |  Volume : 22  |  Issue : 6  |  Page : 402--407

Levels and diagnostic value of model-based insulin sensitivity in sepsis: A preliminary study


1 Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia; Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
2 Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
3 Department of Mechanical Engineering, Universiti Malaysia Pahang, Pahang, Malaysia
4 Advanced Medical and Dental Institute, Universiti Sains Malaysia, Pulau Pinang, Malaysia
5 Department of Mechanical Engineering, College of Engineering, Universiti Tenaga Nasional, Kajang, Selangor, Malaysia

Correspondence Address:
Dr. Azrina Md Ralib
Department of Anaesthesiology and Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang
Malaysia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijccm.IJCCM_92_18

Rights and Permissions

Background and Aims: Currently, there is a lack of real-time metric with high sensitivity and specificity to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models; however, its effectiveness as a diagnostic test of sepsis is unknown. Our aims were to determine the levels and diagnostic value of model-based SI for identification of sepsis in critically ill patients. Materials and Methods: In this retrospective, cohort study, we analyzed SI levels in septic (n = 18) and nonseptic (n = 20) patients at 1 (baseline), 4, 8, 12, 16, 20, and 24 h of their Intensive Care Unit admission. Patients with diabetes mellitus Type I or Type II were excluded from the study. The SI levels were derived by fitting the blood glucose levels, insulin infusion and glucose input rates into the Intensive Control of Insulin-Nutrition-Glucose model. Results: The median SI levels were significantly lower in the sepsis than in the nonsepsis at all follow-up time points. The areas under the receiver operating characteristic curve of the model-based SI at baseline for discriminating sepsis from nonsepsis was 0.814 (95% confidence interval, 0.675–0.953). The optimal cutoff point of the SI test was 1.573 × 10−4 L/mu/min. At this cutoff point, the sensitivity was 77.8%, specificity was 75%, positive predictive value was 73.7%, and negative predictive value was 78.9%. Conclusions: Model-based SI ruled in and ruled out sepsis with fairly high sensitivity and specificity in our critically ill nondiabetic patients. These findings can be used as a foundation for further, prospective investigation in this area.






[FULL TEXT] [PDF]*


        
Print this article     Email this article

Online since 7th April '04
Published by Wolters Kluwer - Medknow