Insulin Resistance as a Prognostic Indicator in Severe Sepsis, Septic Shock and Multiorgan Dysfunction Syndrome

Background: Insulin resistance can be broadly defined as subnormal biological response to normal insulin concentration. Insulin resistance (IR) is one of the major factors in the pathogenesis of sepsis. Aim: To study the Insulin Resistance as Prognostic Indicator in Severe Sepsis, Septic Shock and Multiorgan Dysfunction syndrome (MODS). Materials and Methods: A prospective observational study done at Intensive care unit of Department of Medicine, at the tertiary care health centre of Northern India, it was done between June 2016-to May 2017. Patients with age between 14 to 75 years and satisfying the criteria for severe sepsis, septic shock, MODS according to third international consensus 2016 guidelines was included in the study. Patients on statins and insulin, those who had chronic disease and who had CPR were excluded. Results: A total of 81 patients were enrolled. Mean of fasting blood glucose (FBG), fasting insulin level and insulin resistance of both groups were calculated and compared on Day 1 and Day of outcome. Out of 81 patients 42 were euglycemic (RBS<140 mg/dl) and 39 were hyperglycemic (RBS>140 mg/dl). Mean fasting insulin (13.36+4.95v/s 9.83+4.54) and insulin resistance (6.65+3.84v/s2.41+1.11) of hyperglycemic was found to be significantly (p<.01) higher than euglycemic group of patients. Of 39 hyperglycemic patients 30% (n=13) expired while out of 42 euglycemic patients 28.5% expired (n=12) showing mortality was higher in hyperglycaemic patients and the value was found to be non-significant. Conclusion: In patients of severe sepsis, septic shock and MODS stress induced hyperglycemia and insulin resistance are associated with increased mortality. IR is a good and easily estimated method for assessing, but it is not the appropriate indicator of mortality in patients with severe sepsis and organ failure as there are many other factors which come into interplay leading to poor prognosis.