Early insulin resistance in severe trauma without head injury as outcome predictor? A prospective, monocentric pilot study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Adriano Peris²  Gianfranco Gensini¹  Sara Degl’Innocenti²  Chiara Lazzeri¹  Giovanni Zagli²  Manuela Bonizzoli² 

[1] Heart and Vessel Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139, Florence, Italy;Anaesthesia and Intensive Care Unit of Emergency Department, Careggi Teaching Hospital, Largo Brambilla 3, 50139 Florence, Italy

关键词: Intensive care unit;    Outcome;    Insulin resistance;    Trauma;   

Others  :  826317
DOI  :  10.1186/1757-7241-20-69

 received in 2012-05-13, accepted in 2012-09-28,  发布年份 2012

【 摘 要 】

Background

Hyperglycemia following major trauma is a well know phenomenon related to stress-induced systemic reaction. Reports on glucose level management in patients with head trauma have been published, but the development of insulin resistance in trauma patients without head injury has not been extensively studied. The aim of this study was therefore to investigate the prognostic role of acute insulin-resistance, assessed by the HOMA model, in patients with severe trauma without head injury.

Methods

All patients consecutively admitted to the Intensive Care Unit (ICU) of a tertiary referral center (Careggi Teaching Hospital, Florence, IT) for major trauma without head injury (Jan-Dec 2010) were enrolled. Patients with a previous diagnosis of diabetes mellitus requiring insulin therapy or metabolism alteration were excluded from the analysis. Patients were divided into “insulin resistant” and “non-insulin resistant” based on the Homeostasis Model Assessment index (HOMA IR). Results are expressed as medians.

Results

Out of 175 trauma patients admitted to the ICU during the study period, a total of 54 patients without head trauma were considered for the study, 37 of whom met the inclusion criteria. In total, 23 patients (62.2%) resulted insulin resistant, whereas 14 patients (37.8%) were non-insulin resistant. Groups were comparable in demographic, clinical/laboratory characteristics, and severity of injury. Insulin resistant patients had a significantly higher BMI (P=0.0416), C-reactive protein (P=0.0265), and leukocytes count (0.0301), compared to non-insulin resistant patients. Also ICU length of stay was longer in insulin resistant patients (P=0.0381).

Conclusions

Our data suggest that admission insulin resistance might be used as an early outcome predictor.

【 授权许可】

   
2012 Bonizzoli et al.; licensee BioMed Central Ltd.

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