Model-based insulin sensitivity for early diagnosis of sepsis in critical care

• Main Authors: Wan Shukeri, Wan Fadzlina, Md Ralib, Azrina, Jamaludin, Ummu Kulthum, Mat Nor, Mohd Basri
• Format: Conference or Workshop Item
• Language: English
• Published: 2017
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/58199/3/5.%20ASMIC2017_ModelBasedInsulin.pdf; http://irep.iium.edu.my/58199/; http://msic.org.my/asmic2017/

OBJECTIVES To determine the diagnostic value of model-based insulin sensitivity (SI) as a new sepsis biomarker in critically ill patients, and compare its performance to classical inflammatory parameters. METHODS We monitored hourly SI levels in septic (n=19) and non-septic (n=19) critically ill patients in a 24-hour follow-up study. Patients with type I or type II diabetes mellitus were excluded. SI levels were calculated by a validated glycemic control software, STAR TGC (Stochastic TARgeted Tight Glycemic Controller) (Christchurch, NZ). STAR TGC uses a physiological glucose-insulin system model coupled with stochastic models that capture SI variability in real time. RESULTS The median SI levels were lower in the sepsis group than in the non-sepsis group (1.9 x 10-4 L/mU/min vs 3.7 x 10-4 L/mU/min, P <0.0001). The areas under the receiver operating characteristic curve (AUROC) of the model-based SI for distinguishing non-sepsis from sepsis was 0.911, superior to white cells count (AUROC 0.611) and temperature (AUROC 0.618). The optimal cut-off value of the test was 2.9 x 10-4 L/mU/min. At this cut-off value, the sensitivity and specificity was 88.9% and 84.2%, respectively. The positive predictive value was 84.2%, while the negative predictive value was 88.9%. CONCLUSION The early and relevant decrease of SI in sepsis suggests that it might be a promising novel biomarker of sepsis in critical care. Low SI is diagnostic of sepsis, while high SI rules out sepsis, and these may be determined non-invasively in real time from glycemic control protocol data.