The potential impact of admission insulin levels on patient outcome in the intensive care unit [documento electrónico] / Gisela de la Rosa Echavez, ; Esdras Martín Vásquez Mejía, ; Jorge Hernando Donado Gómez, ; Marisol Bedoya Arias, ; Álvaro Humberto Restrepo Cuartas, ; Gustavo Roncancio, ; Carlos Alberto Cadavid Gutiérrez, ; Fabián Alberto Jaimes Barragán,  . - 2013.
Obra : Journal of Trauma and Acute Care Surgery

Idioma : Inglés (eng)

Palabras clave :	Insulin  insulin resistance  critical care  critical illness  outcome
Resumen :	Background: Blood levels of insulin in patients with critical illness at admission to the intensive care unit (ICU) and its association with in hospital mortality are not fully defined. Our objective was to determine this association in a cohort of patients with critical illness who attended in a mixed ICU. Methods: Prospective cohort was nested in a randomized clinical trial conducted in a 12-bed mixed ICU in a tertiary hospital in Medellin (Colombia). One hundred sixty consecutively admitted patients, 15 years or older, were analyzed. Blood insulin and blood glucose levels were measured at admission to the ICU, as well as Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores. A logistic regression model was created with in-hospital mortality as the outcome. Results: In-hospital mortality was 57 (35.6%) of 160. Survivors had lower Acute Physiology and Chronic Health Evaluation II (median, 13 vs. 17) and lower insulin levels (median, 6.5 vs. 9 µU/mL) than did nonsurvivors. More women than men died (27 [48.2%] of 56 vs. 30 [28.8%] of 104), and 39% of the deaths (n = 22) occurred in patients with sepsis. Patients with insulin levels greater than 15 µU/mL had a higher mortality rate compared with patients with values of 5 µU/mL to 15 µU/mL (odds ratio, 3.57; 95% confidence interval, 1.18–10.8). Conclusion: At admission to the ICU, patients with critical illness showed hyperglycemia and relatively decreased insulin levels. High levels of insulin were independently associated with in-hospital mortality in this study population.
Mención de responsabilidad :	Gisela De La Rosa, Esdras Martin Vasquez, Alvaro Mauricio Quintero, Jorge Hernando Donado, Marisol Bedoya, Alvaro Humberto Restrepo, Gustavo Roncancio, Carlos Alberto Cadavid, Fabian Alberto Jaimes, Grupo de Investigacion en Cuidado Intensivo GICI-HPTU
Referencia :	J Trauma Acute Care Surg. 2013 Jan;74(1):270-5.
DOI (Digital Object Identifier) :	10.1097/TA.0b013e3182788042
PMID :	23271103
En línea :	https://journals.lww.com/jtrauma/Abstract/2013/01000/The_potential_impact_of_adm [...]
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