Insulin Treatment Improves the Systemic Inflammatory Reaction to Severe Trauma

Marc G. Jeschke, Dagmar Klein, David Herndon

Research output: Contribution to journalArticle

175 Citations (Scopus)

Abstract

Objective: Determine the effect of insulin on the systemic inflammatory response, pro- and anti-inflammatory cytokines and hepatic acute-phase-response in severely burned pediatric patients. Summary Background Data: The systemic inflammatory and hepatic acute-phase-response contribute to hypermetabolism, multi-organ failure, and mortality. Insulin has been recently shown to decrease mortality and to prevent the incidence of multi-organ failure in critically ill patients; however, the underlying mechanisms have not been defined. Methods: Thirteen thermally injured children received insulin to maintain blood glucose at a range from 120 to 180 mg/dl, 15 children received no insulin with blood glucose levels also at range from 120 to 180 mg/dl and served as controls. Our outcome measures encompassed the effect of insulin on pro-inflammatory mediators, the hepatic acute-phase-response, fat, and the IGF-I system. Results: Insulin administration decreased pro-inflammatory cytokines and proteins, while increasing constitutive-hepatic proteins (P < 0.05). Burned children receiving insulin required significantly less albumin substitution to maintain normal levels compared with control (P < 0.05). Insulin decreased free fatty acids and serum triglycerides when compared with controls (P < 0.05). Serum IGF-I and IGFBP-3 significantly increased with insulin administration (P < 0.05). Conclusion: Insulin attenuates the inflammatory response by decreasing the pro-inflammatory and increasing the anti-inflammatory cascade, thus restoring systemic homeostasis, which has been shown critical for organ function and survival in critically ill patients.

Original languageEnglish (US)
Pages (from-to)553-560
Number of pages8
JournalAnnals of Surgery
Volume239
Issue number4
DOIs
StatePublished - Apr 2004

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Insulin
Wounds and Injuries
Acute-Phase Reaction
Therapeutics
Liver
Insulin-Like Growth Factor I
Critical Illness
Blood Glucose
Anti-Inflammatory Agents
Cytokines
Tissue Survival
Insulin-Like Growth Factor Binding Protein 3
Mortality
Serum
Nonesterified Fatty Acids
Albumins
Triglycerides
Proteins
Homeostasis
Fats

ASJC Scopus subject areas

  • Surgery

Cite this

Insulin Treatment Improves the Systemic Inflammatory Reaction to Severe Trauma. / Jeschke, Marc G.; Klein, Dagmar; Herndon, David.

In: Annals of Surgery, Vol. 239, No. 4, 04.2004, p. 553-560.

Research output: Contribution to journalArticle

Jeschke, Marc G. ; Klein, Dagmar ; Herndon, David. / Insulin Treatment Improves the Systemic Inflammatory Reaction to Severe Trauma. In: Annals of Surgery. 2004 ; Vol. 239, No. 4. pp. 553-560.
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