• Michael Lehrke, Uli C Broedl, Ingeborg M Biller-Friedmann, Michael Vogeser, Volkmar Henschel, Kirsten Nassau, Burkhard Göke, Erich Kilger, and Klaus G Parhofer.
• Department of Internal Medicine II, University of Munich, Grosshadern Campus, Marchioninistr 15, 81377 Munich, Germany. Michael.Lehrke@med.uni-muenchen.de
• Crit Care. 2008 Jan 1; 12 (6): R157.

IntroductionInflammatory stimuli are causative for insulin resistance in obesity as well as in acute inflammatory reactions. Ongoing research has identified a variety of secreted proteins that are released from immune cells and adipocytes as mediators of insulin resistance; however, knowledge about their relevance for acute inflammatory insulin resistance remains limited. In this study we aimed for a clarification of the relevance of different insulin resistance mediating factors in an acute inflammatory situation.MethodsInsulin resistance was measured in a cohort of 37 non-diabetic patients undergoing cardiac surgery by assessment of insulin requirement to maintain euglycaemia and repeated measurements of an insulin glycaemic index. The kinetics of cortisol, interleukin 6 (IL6), tumour necrosis factor alpha (TNFalpha), resistin, leptin and adiponectin were assessed by repeated measurements in a period of 48 h.ResultsInsulin resistance increased during the observation period and peaked 22 h after the beginning of the operation. IL6 and TNFalpha displayed an early increase with peak concentrations at the 4-h time point. Serum levels of cortisol, resistin and leptin increased more slowly and peaked at the 22-h time point, while adiponectin declined, reaching a base at the 22-h time point. Model assessment identified cortisol as the best predictor of insulin resistance, followed by IL6, leptin and adiponectin. No additional information was gained by modelling for TNFalpha, resistin, catecholamine infusion rate, sex, age, body mass index (BMI), operation time or medication.ConclusionsSerum cortisol levels are the best predictor for inflammatory insulin resistance followed by IL6, leptin and adiponectin. TNFalpha, and resistin have minor relevance as predictors of stress dependent insulin resistance.

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