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 Muhd Shukeri, Wan Fadzlina, Mat Nor, Mohd Basri, Jamaludin, Ummu Kulthum, Mohamad Suhaimi, Fatanah, Abdul Razak, Normy Norfiza, Md Ralib, Azrina
Format:	Article
Language:	English English English
Published:	Wolters Kluwer Medknow Publications 2018
Subjects:	R Medicine (General)
Online Access:	http://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/1/IJCCM_2018_22_6_402_234574.pdf http://irep.iium.edu.my/65353/7/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_SCOPUS.pdf http://irep.iium.edu.my/65353/8/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_WOS.pdf

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spelling	iium-653532018-09-12T08:29:53Z http://irep.iium.edu.my/65353/ Levels and diagnostic value of model-based insulin sensitivity in sepsis: a preliminary study Wan Muhd Shukeri, Wan Fadzlina Mat Nor, Mohd Basri Jamaludin, Ummu Kulthum Mohamad Suhaimi, Fatanah Abdul Razak, Normy Norfiza Md Ralib, Azrina R Medicine (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 analysed 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 cut-off point of the SI test was 1.573 × 10-4 L/mu/min. At this cut-off 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 2018-06-18 Article PeerReviewed application/pdf en http://irep.iium.edu.my/65353/1/IJCCM_2018_22_6_402_234574.pdf application/pdf en http://irep.iium.edu.my/65353/7/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_SCOPUS.pdf application/pdf en http://irep.iium.edu.my/65353/8/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_WOS.pdf Wan Muhd Shukeri, Wan Fadzlina and Mat Nor, Mohd Basri and Jamaludin, Ummu Kulthum and Mohamad Suhaimi, Fatanah and Abdul Razak, Normy Norfiza and Md Ralib, Azrina (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 E-ISSN 1998-359X http://www.ijccm.org/article.asp?issn=0972-5229;year=2018;volume=22;issue=6;spage=402;epage=407;aulast=Muhd;type=0 10.4103/ijccm.IJCCM_92_18
repository_type	Digital Repository
institution_category	Local University
institution	International Islamic University Malaysia
building	IIUM Repository
collection	Online Access
language	English English English
topic	R Medicine (General)
spellingShingle	R Medicine (General) Wan Muhd Shukeri, Wan Fadzlina Mat Nor, Mohd Basri Jamaludin, Ummu Kulthum Mohamad Suhaimi, Fatanah Abdul Razak, Normy Norfiza Md Ralib, Azrina 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 analysed 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 cut-off point of the SI test was 1.573 × 10-4 L/mu/min. At this cut-off 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 Muhd Shukeri, Wan Fadzlina Mat Nor, Mohd Basri Jamaludin, Ummu Kulthum Mohamad Suhaimi, Fatanah Abdul Razak, Normy Norfiza Md Ralib, Azrina
author_facet	Wan Muhd Shukeri, Wan Fadzlina Mat Nor, Mohd Basri Jamaludin, Ummu Kulthum Mohamad Suhaimi, Fatanah Abdul Razak, Normy Norfiza Md Ralib, Azrina
author_sort	Wan Muhd Shukeri, Wan Fadzlina
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://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/ http://irep.iium.edu.my/65353/1/IJCCM_2018_22_6_402_234574.pdf http://irep.iium.edu.my/65353/7/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_SCOPUS.pdf http://irep.iium.edu.my/65353/8/65353_Levels%20and%20Diagnostic%20Value%20of%20Model-based%20Insulin_WOS.pdf
first_indexed	2023-09-18T21:32:44Z
last_indexed	2023-09-18T21:32:44Z
_version_	1777412618812653568

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

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