Association of adiponectin levels and insulin demand in critically ill patients

PURPOSE: Intensive care unit patients usually have a deregulated glucose homeostasis and present with hyperglycemia and hyperinsulinemia, suggesting overall insulin resistance. Adiponectin has significant anti-inflammatory and insulin-sensitizing effects and is diminished in morbidly obese and in critically ill patients. Reduced adiponectin could contribute to insulin resistance in these patients. We examined how far insulin demand in critically ill patients is correlated with patient adiponectin levels. PATIENTS AND METHODS: Adiponectin, resistin, leptin, insulin demand, minimal and maximal blood sugar levels, epinephrine, and hydrocortisone demand were measured 1 day after diagnosis of severe sepsis or septic shock in 25 patients (8 female, 17 male; median age 65 years; range: 31 to 87 years). RESULTS: Insulin demand (range: 0–8 IU/h; median 3.5 IU) was positively correlated with serum adiponectin levels (median: 10.1 μg/mL; range: 2.9–47.6 μg/mL; r = +0.56, P < 0.01). There was no significant correlation between insulin demand and leptin serum levels (median: 18.1 ng/mL; range: 0.3–80.7 ng/mL; r = +0.29, P = 0.08) or resistin serum levels (median: 103.9 ng/mL; range: 14.7–352.3 ng/mL; r = +0.13, P = 0.27). Epinephrine demand (median: 0.08 μg/kg*min; range: 0.02–0.63 μg/kg*min) was negatively correlated with male adiponectin levels (r = −0.58; P < 0.01; females: r = −0.36; P = 0.19) and positively correlated with resistin levels (r = 0.43; P = 0.02). Patient body mass index (median 26 kg/m(2); range: 18–37) was positively correlated with serum leptin (r = 0.60; P < 0.01) but was not correlated with insulin demand (r = 0.19; P = 0.19), or adiponectin (females: r = −0.37, P = 0.18; males: r = −0.16, P = 0.27), or resistin levels (r = +0.17; P = 0.21). CONCLUSION: Adiponectin levels and insulin demand were positively correlated during sepsis. Adiponectin levels were negatively correlated with epinephrine demand in male patients and epinephrine demand was positively correlated with resistin levels, which might have increased insulin resistance. The relationship between adiponectin and insulin action in humans is more complex than often suggested.