Marco Castillo-Rodriguez, Anesthesiology Resident
MD, Msc
Mount Sinai Medical Center, Florida, United States
Disclosure information not submitted.
Miguel Perez-Viloria
MD
Mount Sinai Medical Center, United States
Disclosure information not submitted.
Title: Changes in serum adipokines are associated with insulin resistance in critically ill patients.
Introduction: Insulin resistance and hyperglycemia are common features of critical illness. Hyperglycemia in the ICU is linked to worse outcomes. Leptin, ghrelin, and adiponectin are hormones associated with inflammation, metabolism regulation, and insulin resistance. The study aims to determine if Adipokine levels at admission are associated with insulin resistance and outcomes in septic and critically ill patients.
Methods: This study is a posthoc analysis of a prospective observational study performed in the medical ICU of the Hospital Clinic of Barcelona. Pearson’s correlation coefficients between variables were calculated with a two-tailed analysis. Outcomes were defined as the length of stay (LOS), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), insulin levels, and mortality. Adipokines levels were compared in survivors vs. non-survivors and patients with high HOMA-IR vs. Low HOMA-IR.
Results: Hospital LOS were inversely correlated with leptin levels (r = -0.22, p = 0.02) and higher ghrelin levels (r = 0.23, p = 0.01). There was no association with adiponectin levels, ICU or hospital LOS (see table 1). Leptin was found in patients with higher HOMA-IR (r = 2.43, p = 0.01) and insulin levels (r = 0.278, p = 0.003). This correlates with the results of the comparison between the HOMA-IR score > 3 group and HOMA-IR < 3 group.
Conclusions: Critically ill patients tend to present with high insulin resistance independent of their initial BMI. Adiponectin levels during the first 24 hours of admission are a poorly reliable marker of outcomes in the critically ill. Higher leptin levels are associated with better results, but there is also a positive correlation between leptin and insulin resistance.
Ghrelin plays a role in mediating response to critical illness. Insulin resistance is associated with higher admission leptin and ghrelin levels in critically ill patients.