Quantifying the Homeostatic Model Assessment of Insulin Resistance to Predict Mortality in Multi-organ Dysfunction...

Area of Science:

• Critical Care Medicine
• Endocrinology
• Metabolic Syndrome

Background:

• Insulin resistance is a key factor in multi-organ dysfunction syndrome (MODS), contributing to increased mortality.
• Predicting mortality in non-diabetic MODS patients is crucial for effective clinical management.

Purpose of the Study:

• To determine a specific cutoff value for the homeostatic model assessment of insulin resistance (HOMA-IR) during ICU admission.
• To evaluate HOMA-IR's predictive capability for 28-day mortality in non-diabetic MODS patients.

Main Methods:

• A prospective, blinded cohort study involving 82 non-diabetic MODS patients.
• Fasting blood glucose (FBG) and insulin levels (FIL) were measured to calculate HOMA-IR.
• Statistical analysis included ROC curves, Youden index, correlation, and regression to identify mortality predictors.

Main Results:

• An optimal HOMA-IR cutoff value of ≥1.61 predicted 28-day mortality with 95.5% specificity and 36.8% sensitivity (AUC: 0.684).
• Patients with HOMA-IR ≥1.61 had significantly lower 28-day survival (p=0.001), with an odds ratio of 12.25.
• Mean HOMA-IR was significantly higher in non-survivors (1.38 ± 1.14) compared to survivors (0.76 ± 0.61) (p=0.004).

Conclusions:

• HOMA-IR is a significant predictor of mortality in patients with MODS.
• The identified HOMA-IR cutoff value (≥1.61) can aid in risk stratification for critically ill patients.
• Integrating HOMA-IR with existing disease severity scores may enhance prognostication in MODS.