[The changes in insulin sensitivity under stress and its clinical significance in the critically ill patients]

To observe the changes in blood glucose, serum insulin level and insulin resistance of critically ill patients during the acute stage and explore the relationship between the changes and their prognosis.

Fifty-four patients in intensive care unit (ICU) were enrolled. All the patients were assessed with acute physiology and chronic health evaluation II (APACHE II) scores in 24 hours after admission. Fasting blood glucose (FBG) and fasting insulin (FINS) were determined within 24 hours or the next morning, and then insulin resistance was evaluated by insulin sensitivity index (ISI). According to the APACHE II scores, the severity and prognosis, the patients were stratified into groups respectively. The difference in APACHE II scores, FBG, FINS and ISI among groups were analyzed. Furthermore, the correlation between APACHE II score and FBG, FINS, ISI were studied respectively.

Based on APACHE II scores, the patients were divided into group A (APACHE II scoresor=21). The levels of FBG and FINS were found to be elevated with the increase in APACHE II score, and in contrast ISI greatly reduced (P<0.05 or P<0.01). APACHE II scores, FBG and FINS in multiple organ dysfunctions group were significantly higher than in single organ dysfunction group, and ISI was found to be significantly decreased (P<0.05 or P<0.01). Additionally, APACHE II scores and FBG in non-survivor group were obviously higher than those in survivor group, while ISI was markedly lower (all P<0.01), but no difference in FINS levels was found between the two groups. In the 54 critically ill patients, correlation study showed that significant positive correlation was found between FBG and APACHE II score (r=0.816 5, P<0.01, regression equation : y=0.573x+3.072) and significant negative correlation between ISI and APACHE II score (r=-0.703 9, P<0.01, regression equation : y=-0.107x-3.598), but no linear correlation was found between APACHE II score and FINS (r=0.283 0, P>0.05).

The study suggests that FBG and ISI could be used to evaluate the severity and prognosis. Hyperinsulinemia is found in some critically ill patients, but FINS is not helpful for assessing the severity and outcome.