c-peptide and Wounds-and-Injuries

Hyperglycemia following major trauma is a well know phenomenon related to stress-induced systemic reaction. Reports on glucose level management in patients with head trauma have been published, but the development of insulin resistance in trauma patients without head injury has not been extensively studied. The aim of this study was therefore to investigate the prognostic role of acute insulin-resistance, assessed by the HOMA model, in patients with severe trauma without head injury.. All patients consecutively admitted to the Intensive Care Unit (ICU) of a tertiary referral center (Careggi Teaching Hospital, Florence, IT) for major trauma without head injury (Jan-Dec 2010) were enrolled. Patients with a previous diagnosis of diabetes mellitus requiring insulin therapy or metabolism alteration were excluded from the analysis. Patients were divided into "insulin resistant" and "non-insulin resistant" based on the Homeostasis Model Assessment index (HOMA IR). Results are expressed as medians.. Out of 175 trauma patients admitted to the ICU during the study period, a total of 54 patients without head trauma were considered for the study, 37 of whom met the inclusion criteria. In total, 23 patients (62.2%) resulted insulin resistant, whereas 14 patients (37.8%) were non-insulin resistant. Groups were comparable in demographic, clinical/laboratory characteristics, and severity of injury. Insulin resistant patients had a significantly higher BMI (P=0.0416), C-reactive protein (P=0.0265), and leukocytes count (0.0301), compared to non-insulin resistant patients. Also ICU length of stay was longer in insulin resistant patients (P=0.0381).. Our data suggest that admission insulin resistance might be used as an early outcome predictor.

Topics: Adult; Body Mass Index; C-Peptide; C-Reactive Protein; Female; Humans; Hyperglycemia; Infections; Insulin Resistance; Intensive Care Units; Length of Stay; Leukocyte Count; Logistic Models; Male; Middle Aged; Pilot Projects; Prognosis; Prospective Studies; Respiration, Artificial; Wounds and Injuries

Topics: Acute Disease; Adolescent; Adult; Blood Glucose; C-Peptide; Carbohydrate Metabolism; Glucose Tolerance Test; Humans; Hydrocortisone; Insulin; Male; Trauma Severity Indices; Wounds and Injuries

To evaluate the influence of aging on the increase in endogenous glucose production that follows injury, we studied 22 fully resuscitated, clinically stable, previously healthy patients aged < or = 30 yr or > or = 60 yr admitted to hospital following injury, and 11 healthy volunteers in the same age groups. Endogenous glucose production was determined using a primed constant infusion of D-glucose-6,6-2d2. Urine cortisol and C-peptide were markedly higher in patients than volunteers (both P < 0.01), and urine C-peptide was lower in older than in younger patients (P < 0.05). Urine cortisol increased as a function of the interaction of age and Injury Severity Score (ISS) (r2 = 0.40, P < 0.001). Intracellular water was markedly lower and extracellular water greater in patients compared with volunteers (both P < 0.001), reflecting the loss of body cell mass and expansion of the extracellular space following injury. Endogenous glucose production (milligrams per minute per liter intracellular water) was best described as a function of ISS and age-ISS interaction (r2 = 0.35, all P < 0.05), and was increased 56% and 78% in younger and older patients, respectively, in comparison with the respective volunteer groups. Endogenous glucose production following injury increases in relation to the severity of injury and patient age. Greater cortisol elaboration and diminished insulin secretion in older patients may contribute to this age effect.

Topics: Adult; Aged; Aging; Blood Glucose; Body Composition; C-Peptide; Female; Glucose; Hormones; Humans; Hydrocortisone; Insulin; Male; Middle Aged; Reference Values; Trauma Severity Indices; Wounds and Injuries

We investigated the responsiveness of whole-body protein and glucose kinetics to severe trauma and the role of regulatory hormones in the early catabolic "flow phase" of injury in a group of patients ranging in age from 19 to 85. Energy metabolism (indirect calorimetry), protein kinetics (primed-constant infusion of [15N]glycine), glucose metabolism (primed-constant infusion of [U-14C]glucose and [6-3H]glucose), and circulating hormone levels were measured during basal conditions within 48 to 60 hours after injury when the patients were receiving maintenance fluids without N or calories. Experimental data were analyzed as two groups (young, age 18 to 59, and elderly, age 60 to 85) and also as linear function of advancing age. The geriatric trauma (GT) group lost less N (11.9 +/- 1.3 v 17.7 +/- 1.7 g N/d, P = .025) than the younger group, mainly due to a significantly decreased whole-body protein breakdown (WBPB) rate. Despite a similar production and oxidation rate of glucose, hyperglycemia was more exaggerated in the elderly group. Advancing age resulted in significant positive correlations with plasma glucose levels and negative correlations with circulating growth hormone levels, urinary nitrogen loss, and protein turnover. These results suggest an age- and body composition-related reduced energy and protein metabolic response to severe trauma in elderly individuals.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Ammonia; C-Peptide; Calorimetry, Indirect; Carbon Radioisotopes; Energy Metabolism; Female; Glucose; Glycine; Humans; Hydrocortisone; Insulin; Male; Middle Aged; Nitrogen; Nitrogen Isotopes; Proteins; Tritium; Wounds and Injuries

Leucine and glucose turnover were measured using simultaneous infusions of [13C]leucine and [2H]glucose before and during an infusion of Na DL-hydroxybutyrate (Na DL-HB) in overnight-fasted patients the day before and 3 days after total hip replacement. The ketone body infusion before surgery resulted in a significant increase in plasma leucine concentration and leucine turnover, while glucose concentration and turnover decreased. Surgery increased leucine turnover. Ketone body infusion after surgery caused a further increased leucine turnover while turnover fell as before surgery. We suggest that exogenous ketone bodies decrease hepatic glucose production and probably stimulate a rise in protein synthesis above breakdown leading to a decreased nitrogen excretion as observed by other investigators. Despite the metabolic adaptation to trauma, this response was not affected by surgery.

Topics: Aged; Blood Glucose; C-Peptide; Carbon Isotopes; Deuterium; Female; Glucose; Hip Prosthesis; Humans; Hydroxybutyrates; Infusions, Intravenous; Insulin; Ketone Bodies; Kinetics; Leucine; Male; Middle Aged; Proteins; Wounds and Injuries

Topics: Amino Acids; Betamethasone; Brain Injuries; C-Peptide; Energy Metabolism; Fructose; Glucagon; Glucose Solution, Hypertonic; Humans; Hydrocortisone; Insulin; Nutritional Requirements; Parenteral Nutrition; Thyroid Hormones; Wounds and Injuries; Xylose