Levels and diagnostic value of model-based insulin sensitivity in sepsis: A preliminary study
Wan Fadzlina Wan Muhd Shukeri, Mohd Basri Mat-Nor, Ummu Kulthum Jamaludin, Fatanah Suhaimi, Normy Norafiza Abd Razak, Azrina Md Ralib
Critical care, diagnosis, insulin sensitivity, model-based, sepsis
Citation Information :
Shukeri WF, Mat-Nor MB, Jamaludin UK, Suhaimi F, Razak NN, Ralib AM. Levels and diagnostic value of model-based insulin sensitivity in sepsis: A preliminary study. Indian J Crit Care Med 2018; 22 (6):402-407.
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.
Vincent JL. The clinical challenge of sepsis identification and monitoring. PLoS Med 2016;13:e1002022.
Carrigan SD, Scott G, Tabrizian M. Toward resolving the challenges of sepsis diagnosis. Clin Chem 2004;50:1301-14.
Agwunobi AO, Reid C, Maycock P, Little RA, Carlson GL. Insulin resistance and substrate utilization in human endotoxemia. J Clin Endocrinol Metab 2000;85:3770-8.
Chambrier C, Laville M, Rhzioual Berrada K, Odeon M, Boulétreau P, Beylot M, et al. Insulin sensitivity of glucose and fat metabolism in severe sepsis. Clin Sci (Lond) 2000;99:321-8.
Rusavy Z, Macdonald IA, Sramek V, Lacigova S, Tesinsky P, Novak I, et al. Glycemia influences on glucose metabolism in sepsis during hyperinsulinemic clamp. JPEN J Parenter Enteral Nutr 2005;29:171-5.
Virkamäki A, Yki-Järvinen H. Mechanisms of insulin resistance during acute endotoxemia. Endocrinology 1994;134:2072-8.
Blakemore A, Wang SH, Le Compte A, M Shaw G, Wong XW, Lin J, et al. Model-based insulin sensitivity as a sepsis diagnostic in critical care. J Diabetes Sci Technol 2008;2:468-77.
Suhaimi FM, Chase JG, Pretty CG, Shaw GM, Razak NN, Jamaludin UK. Insulin sensitivity and sepsis score: A correlation between model-based metric and sepsis scoring system in critically ill patients. Biomed Signal Process Control 2017;32:112-23.
Li L, Messina JL. Acute insulin resistance following injury. Trends Endocrinol Metab 2009;20:429-35.
Chase JG, Shaw GM, Lotz T, LeCompte A, Wong J, Lin J, et al. Model-based insulin and nutrition administration for tight glycaemic control in critical care. Curr Drug Deliv 2007;4:283-96.
Lotz TF, Chase JG, McAuley KA, Shaw GM, Wong XW, Lin J, et al. Monte Carlo analysis of a new model-based method for insulin sensitivity testing. Comput Methods Programs Biomed 2008;89:215-25.
Lin J, Razak NN, Pretty CG, Le Compte A, Docherty P, Parente JD, et al. Aphysiological intensive control insulin-nutrition-glucose (ICING) model validated in critically ill patients. Comput Methods Programs Biomed 2011;102:192-205.
Malaysian Society of Intensive Care. Blood glucose management in the intensive care unit: Insulin infusion protocol. Management protocols in ICU 2012;2:73-5.
Health Ministry of Malaysia. Clinical practice guidelines; management of type 2 diabetes. Clin Pract Guidel Manag Type 2 Diabetes 2009;5:73.
Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003;31:1250-6.
Bewick V, Cheek L, Ball J. Statistics review 13: Receiver operating characteristic curves. Crit Care 2004;8:508-12.
Cook NR. Use and misuse of the receiver operating characteristic curve in risk prediction. Circulation 2007;115:928-35.
Lotz TF, Chase JG, McAuley KA, Shaw GM, Docherty PD, Berkeley JE, et al. Design and clinical pilot testing of the model-based dynamic insulin sensitivity and secretion test (DISST). J Diabetes Sci Technol 2010;4:1408-23.
Dimitriadis G, Leighton B, Parry-Billings M, Sasson S, Young M, Krause U, et al. Effects of glucocorticoid excess on the sensitivity of glucose transport and metabolism to insulin in rat skeletal muscle. Biochem J 1997;321(Pt 3):707-12.
Qi D, Rodrigues B. Glucocorticoids produce whole body insulin resistance with changes in cardiac metabolism. Am J Physiol Endocrinol Metab 2007;292:E654-67.
Chan T, Gu F. Early diagnosis of sepsis using serum biomarkers. Expert Rev Mol Diagn 2011;11:487-96.
Plummer MP, Bellomo R, Cousins CE, Annink CE, Sundararajan K, Reddi BA, et al. Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality. Intensive Care Med 2014;40:973-80.
Krinsley JS, Egi M, Kiss A, Devendra AN, Schuetz P, Maurer PM, et al. Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: An international multicenter cohort study. Crit Care 2013;17:R37.
Hensen J, Thomas T, Mueller-Ziehm J, Worthmann W, Kleine E, Behrens EM, et al. Management of diabetes mellitus and hospital-related hyperglycemia in patients of a medical ICU, with the use of two “down-to-earth” protocols: A feasibility study. Exp Clin Endocrinol Diabetes 2007;115:577-83.