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Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study

Background and Aims: Currently, there is a lack of real‑time metric with high sensitivity and specificity to diagnose sepsis. Insulin sensitivity (SI) may be determined in real‑time using mathematical glucose‑insulin models; however, its effectiveness as a diagnostic test of sepsis is unknown. Our a...

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Main Authors: Wan Fadzlina, Muhd Shukeri, Mohd Basri, Mat Nor, Ummu Kulthum, Jamaludin, Fatanah, M. Suhaimi, Normy Norfiza, A. Razak, Azrina, Md Ralib
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2018
Subjects:
Q Science (General)
Online Access:http://umpir.ump.edu.my/id/eprint/21404/1/Levels%20and%20Diagnostic%20Value%20of%20Model%E2%80%91based%20Insulin%20Sensitivity.pdf
http://umpir.ump.edu.my/id/eprint/21404/
http://www.ijccm.org/text.asp?2018/22/6/402/234574
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spelling my.ump.umpir.214042019-07-17T02:50:20Z http://umpir.ump.edu.my/id/eprint/21404/ Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study Wan Fadzlina, Muhd Shukeri Mohd Basri, Mat Nor Ummu Kulthum, Jamaludin Fatanah, M. Suhaimi Normy Norfiza, A. Razak Azrina, Md Ralib Q Science (General) Background and Aims: Currently, there is a lack of real‑time metric with high sensitivity and specificity to diagnose sepsis. Insulin sensitivity (SI) may be determined in real‑time using mathematical glucose‑insulin models; however, its effectiveness as a diagnostic test of sepsis is unknown. Our aims were to determine the levels and diagnostic value of model‑based SI for identification of sepsis in critically ill patients. Materials and Methods: In this retrospective, cohort study, we analyzed SI levels in septic (n = 18) and nonseptic (n = 20) patients at 1 (baseline), 4, 8, 12, 16, 20, and 24 h of their Intensive Care Unit admission. Patients with diabetes mellitus Type I or Type II were excluded from the study. The SI levels were derived by fitting the blood glucose levels, insulin infusion and glucose input rates into the Intensive Control of Insulin‑Nutrition‑Glucose model. Results: The median SI levels were significantly lower in the sepsis than in the nonsepsis at all follow‑up time points. The areas under the receiver operating characteristic curve of the model‑based SI at baseline for discriminating sepsis from nonsepsis was 0.814 (95% confidence interval, 0.675–0.953). The optimal cutoff point of the SI test was 1.573 × 10−4 L/mu/min. At this cutoff point, the sensitivity was 77.8%, specificity was 75%, positive predictive value was 73.7%, and negative predictive value was 78.9%. Conclusions: Model‑based SI ruled in and ruled out sepsis with fairly high sensitivity and specificity in our critically ill nondiabetic patients. These findings can be used as a foundation for further, prospective investigation in this area. Wolters Kluwer Medknow Publications 2018 Article PeerReviewed pdf en http://umpir.ump.edu.my/id/eprint/21404/1/Levels%20and%20Diagnostic%20Value%20of%20Model%E2%80%91based%20Insulin%20Sensitivity.pdf Wan Fadzlina, Muhd Shukeri and Mohd Basri, Mat Nor and Ummu Kulthum, Jamaludin and Fatanah, M. Suhaimi and Normy Norfiza, A. Razak and Azrina, Md Ralib (2018) Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study. Indian Journal of Critical Care Medicine, 22 (6). pp. 402-407. ISSN 0972-5229 http://www.ijccm.org/text.asp?2018/22/6/402/234574 10.4103/ijccm.IJCCM_92_18
institution Universiti Malaysia Pahang
building UMP Library
collection Institutional Repository
continent Asia
country Malaysia
content_provider Universiti Malaysia Pahang
content_source UMP Institutional Repository
url_provider http://umpir.ump.edu.my/
language English
topic Q Science (General)
spellingShingle Q Science (General)
Wan Fadzlina, Muhd Shukeri
Mohd Basri, Mat Nor
Ummu Kulthum, Jamaludin
Fatanah, M. Suhaimi
Normy Norfiza, A. Razak
Azrina, Md Ralib
Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
description Background and Aims: Currently, there is a lack of real‑time metric with high sensitivity and specificity to diagnose sepsis. Insulin sensitivity (SI) may be determined in real‑time using mathematical glucose‑insulin models; however, its effectiveness as a diagnostic test of sepsis is unknown. Our aims were to determine the levels and diagnostic value of model‑based SI for identification of sepsis in critically ill patients. Materials and Methods: In this retrospective, cohort study, we analyzed SI levels in septic (n = 18) and nonseptic (n = 20) patients at 1 (baseline), 4, 8, 12, 16, 20, and 24 h of their Intensive Care Unit admission. Patients with diabetes mellitus Type I or Type II were excluded from the study. The SI levels were derived by fitting the blood glucose levels, insulin infusion and glucose input rates into the Intensive Control of Insulin‑Nutrition‑Glucose model. Results: The median SI levels were significantly lower in the sepsis than in the nonsepsis at all follow‑up time points. The areas under the receiver operating characteristic curve of the model‑based SI at baseline for discriminating sepsis from nonsepsis was 0.814 (95% confidence interval, 0.675–0.953). The optimal cutoff point of the SI test was 1.573 × 10−4 L/mu/min. At this cutoff point, the sensitivity was 77.8%, specificity was 75%, positive predictive value was 73.7%, and negative predictive value was 78.9%. Conclusions: Model‑based SI ruled in and ruled out sepsis with fairly high sensitivity and specificity in our critically ill nondiabetic patients. These findings can be used as a foundation for further, prospective investigation in this area.
format Article
author Wan Fadzlina, Muhd Shukeri
Mohd Basri, Mat Nor
Ummu Kulthum, Jamaludin
Fatanah, M. Suhaimi
Normy Norfiza, A. Razak
Azrina, Md Ralib
author_facet Wan Fadzlina, Muhd Shukeri
Mohd Basri, Mat Nor
Ummu Kulthum, Jamaludin
Fatanah, M. Suhaimi
Normy Norfiza, A. Razak
Azrina, Md Ralib
author_sort Wan Fadzlina, Muhd Shukeri
title Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
title_short Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
title_full Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
title_fullStr Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
title_full_unstemmed Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
title_sort levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study
publisher Wolters Kluwer Medknow Publications
publishDate 2018
url http://umpir.ump.edu.my/id/eprint/21404/1/Levels%20and%20Diagnostic%20Value%20of%20Model%E2%80%91based%20Insulin%20Sensitivity.pdf
http://umpir.ump.edu.my/id/eprint/21404/
http://www.ijccm.org/text.asp?2018/22/6/402/234574
_version_ 1643669121004470272
score 13.211869

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