Model-based insulin sensitivity as a new biomarker of sepsis diagnosis in the intensive care unit

• Main Authors: Wan Shukeri, Wan Fadzlina, Jamaludin, Ummu Kulthum, Md Ralib, Azrina, Mat Nor, Mohd Basri
• Format: Article
• Language: English; English; English
• Published: International Islamic University Malaysia 2021
• Subjects: RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
• Online Access: http://irep.iium.edu.my/89162/1/1008-Manuscript-7623-1-10-20210331.pdf; http://irep.iium.edu.my/89162/7/89162_Model-Based%20Insulin%20Sensitivity%20as%20a%20New%20Biomarker_scopus.pdf; http://irep.iium.edu.my/89162/8/89162_Model-Based%20Insulin%20Sensitivity%20as%20a%20New%20Biomarker_wos.pdf; http://irep.iium.edu.my/89162/; https://journals.iium.edu.my/kom/index.php/imjm/article/view/1008; https://doi.org/10.31436/imjm.v20i2.1008
• Institution: Universiti Islam Antarabangsa Malaysia

INTRODUCTION: Currently, there is a lack of real-time biomarker to diagnose sepsis. Insulin sensitivity (SI) may be determined in real-time using mathematical glucose-insulin models, but its effectiveness as a diagnostic test of sepsis remains unexplored. We aimed to explore the diagnostic value of model-based SI as a new biomarker of sepsis in a mixed cohort of diabetic and non-diabetic patients newly admitted to the intensive care unit (ICU). MATERIALS AND METHODS: In this cross-sectional study, we analysed SI levels derived from the IntensiveControl-of-Insulin-Nutrition-Glucose model in septic (n=45) and non-septic (n = 41) patients upon their ICU admission. The diagnostic value of model-based SI for sepsis was determined through analysis of the area under the curve (AUC) of the receiver operating characteristic curve. RESULTS: Baseline SI levels were significantly lower in patients with sepsis than those without sepsis (0.560 (SD=0.676) vs. 1.097 (SD=1.473) x 10-4 L/mU/min, P = 0.037). However, the AUC of 0.588 revealed that model-based SI was a poor diagnostic test of sepsis in the mixed cohort of diabetics and non-diabetics. In a separate analysis among the non-diabetics (n=19), model-based SI predicted sepsis with clinically valid performance (AUC 0.911). CONCLUSION: Presence of sepsis significantly reduced SI in the critically ill patients but a low SI could predict sepsis only in the non-diabetic cohort.