The Role of Insulin Resistance in Outcome of Patients with Multi Organ Dysfunction Syndrome

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The Role of Insulin Resistance in Outcome of Patients with Multi Organ Dysfunction Syndrome

Journal Title: Journal of Medical Science And clinical Research - Year 2016, Vol 4, Issue 12

Abstract

Background: Multi organ dysfunction syndrome (MODS) as the name implies, is a syndrome, not a specific disease entity, manifested by organ dysfunction affecting more than one organ. Sepsis and Multi organ dysfunction syndrome (MODS) is a common cause of mortality and morbidity. Sepsis can progress to septic shock and Multi organ dysfunction syndrome is well established as the final stage of the continuum. Sepsis and acute stress injury like MODS is an insulin resistance state and degree of insulin resistance is directly proportional to the severity of stress response. Methodology: This was a case control study conducted in which 75 cases diagnosed to have MODS without any history of impaired glucose tolerance or other endocrine disorders were recruited and their results compared with 75 healthy controls. Fasting insulin level (FIL) and fasting blood sugar (FBS) levels were taken and Insulin resistance (IR) was calculated using HOMA . IR was compared with cases and controls and its relation with severity and outcome in patient with multi-organ dysfunction syndrome was noted and analyzed. Observations: The result of the study showed that IR among MODS cases was 34.7% (n=26) as compared to 12% (n=9) in controls, p(<0.001). The mean FBS, FIL and HOMA IR levels in cases were higher (150.65 ±62.41, 4.122 ± 3.28 and 1.477 ± 1.28) as compared to controls (91.43 ± 25.67, 1.68 ± 1.35 and 0.418 ±0.47) respectively (p value<0.001). Among the cases with MODS there was 41.3% (n=75) mortality. There was no mortality in controls. The mean FBS, FIL and HOMA IR values were higher in non-survivors than survivors with (z score = 2.27, 5.94, 4.83) respectively (p value <0.05). Among the non survivors 64.5%(n=31) had insulin resistance as compared to survivors 13.6%(n=44), association of IR was strongly positive with mortality (p<0.001).Mortality was higher in ≥ 4 organ failure cases (60%) as compared to < 4 organ failure cases (32%). The mean HOMA IR value increased with the number of systems being involved (0.54,1.286,1.85 and 2.72 for 2,3,4and 5 organ involvement respectively)inferring that IR increased with severity of MODS. Conclusion: Insulin resistance plays a important risk associated with mortality among the cases of MODS and increase in HOMA IR values is an alarming situation. Studies over a decade have shown that preventing acute hyperglycemia with insulin therapy substantially improves the outcome in critically ill patients with multi organ failure. Therefore, estimation of IR can be used as an objective tool, in patients with MODS to lessen the severity of MODS and to provide a better outcome with respect to mortality.

Authors and Affiliations

Dr Ritu Gupta

Keywords

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