Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients
Serum resistin levels in critically ill patients are associated with inflammation, organ dysfunction and metabolism and may predict survival of non-septic patients
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DOI：
10.1186/cc7925
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发表时间：
2009-01-01
期刊：
影响因子：
15.1
通讯作者：
Trautwein, Christian
中科院分区：
文献类型：
--
作者：
Koch, Alexander;Gressner, Olav A.;Trautwein, Christian
引入重症监护病房（ICU）的重症患者的血糖水平和胰岛素抵抗已被确定为影响死亡率的因素。重症患者中胰岛素抵抗（IR）的发病机理是复杂的，尚未完全理解。抵抗素是一种激素，主要源自人类中的巨噬细胞和啮齿动物的脂肪组织，可调节葡萄糖代谢和胰岛素敏感性。在非疾病患者中，发现抵抗素与葡萄糖耐受性受损，胰岛素抵抗，代谢综合征，肥胖和2型糖尿病有关。因此，抵抗素可能代表危重患者的炎症，急性期反应和胰岛素抵抗之间的联系。我们的目的是检查重症患者的炎症，器官功能，代谢，疾病严重程度和生存的参数的血清抗素浓度与患者的炎症参数的相关性。入院时使用了医疗ICU，170名患者（122例败血症，48例无脓毒症）被研究前瞻性并与60个健康的非糖尿病对照进行了比较。评估了临床数据，各种实验室参数，代谢和内分泌功能以及研究性炎症性细胞因子谱。与健康对照组相比，所有重症监护患者的抗药性血清浓度均显着升高，而败血症的抗性血清浓度均显着升高，而败血症的抗性血清浓度均显着升高。血清抗素浓度与现有的2型糖尿病或肥胖症无关。对于所有重症患者，显示了与胰岛素抵抗（HOMA-IR）的稳态模型评估指数的相关性。血清抗素浓度与炎症参数紧密相关，例如C反应蛋白，白细胞，促脂蛋白和细胞因子，例如IL6和TNF-Alpha，以及与肾衰竭和肾功能衰竭和肝合成能力相关。高抗素水平（> 10 ng/ml）与非塞斯病患者的ICU和总体生存率的不利结果有关。缔解率抗败血症或全身性炎症反应综合征（SIRS）引起的急性炎症中的结论性血清抵抗素浓度升高。与其他急性期蛋白的密切相关性表明，ICU患者中巨噬细胞释放了主要的，临床上相关的抵抗素。此外，抵抗蛋白可能有可能作为非杰出患者的预后生物标志物。
Introduction Blood glucose levels and insulin resistance in critically ill patients on admission to intensive care units (ICUs) have been identified as factors influencing mortality. The pathogenesis of insulin resistance (IR) in critically ill patients is complex and not fully understood. Resistin is a hormone mainly derived from macrophages in humans and from adipose tissue in rodents, which regulates glucose metabolism and insulin sensitivity. In non-critically ill patients, resistin was found to be related to impaired glucose tolerance, insulin resistance, metabolic syndrome, obesity and type 2 diabetes. Therefore, resistin might represent a link between inflammation, acute phase response and insulin resistance in critically ill patients. We aimed to examine the correlation of serum resistin concentrations to parameters of inflammation, organ function, metabolism, disease severity and survival in critically ill patients.Methods On admission to the Medical ICU, 170 patients ( 122 with sepsis, 48 without sepsis) were studied prospectively and compared with 60 healthy non-diabetic controls. Clinical data, various laboratory parameters, metabolic and endocrine functions as well as investigational inflammatory cytokine profiles were assessed. Patients were followed for approximately three years.Results Resistin serum concentrations were significantly elevated in all critical care patients compared with healthy controls, and significantly higher in sepsis than in non-sepsis patients. Serum resistin concentrations were not associated with pre-existing type 2 diabetes or obesity. For all critically ill patients, a correlation to the homeostasis model assessment index of insulin resistance (HOMA-IR) was shown. Serum resistin concentrations were closely correlated to inflammatory parameters such as C-reactive protein, leukocytes, procalcitonin, and cytokines such as IL6 and TNF-alpha, as well as associated with renal failure and liver synthesis capacity. High resistin levels (> 10 ng/ml) were associated with an unfavourable outcome in non-sepsis patients on ICU and the overall survival.Conclusions Serum resistin concentrations are elevated in acute inflammation due to sepsis or systemic inflammatory response syndrome (SIRS). The close correlation with other acute phase proteins suggests a predominant, clinically relevant resistin release from macrophages in ICU patients. Moreover, resistin could potentially serve as a prognostic biomarker in non-sepsis critically ill patients.