PDF(Pubmed)
Abstract：
UNASSIGNED: Insulin resistance is often implicated as a risk factor of cell-mediated immune dysfunction in sepsis patients and results in poor clinical outcome. However, it is unclear whether early insulin resistance is contributory to T-cell dysfunction and poor clinical outcome in coronavirus disease 2019 (COVID-19) patients.
UNASSIGNED: Adult patients with moderate-to-severe or critically ill COVID-19 infection were included in this study. Serum samples were collected at the time of diagnosis for fasting plasma glucose, serum insulin, serum cortisol, and serum glucagon measurements, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score was calculated.
UNASSIGNED: One hundred and twenty-six subjects with a mean (standard deviation) age of 49.6 (16.3) years were recruited in this study, and 62.4% (78 of 125 patients) were male. HOMA-IR was a predictor of inhospital mortality with the area under the receiver operating characteristics curve (AUROC) (95% confidence interval [CI] of 0.61 [0.49-0.73]). With a cutoff value of 1.91, sensitivity was 75.5% and specificity was 45.2%. Higher serum insulin was associated with higher survival with AUROC (95% CI) of 0.65 (0.53-0.76), and the best cutoff was 7.15, with a sensitivity and specificity of 62.1% and 64.5%. Serum cortisol was also a predictor of inhospital mortality with an AUROC (95% CI) of 0.67 (0.56-0.77).
UNASSIGNED: An independent association between baseline serum cortisol and poor outcome in moderate-to-severe COVID-19 patients was observed. Hyperglycemia and HOMA-IR can also predict poor outcome in these patients with some accuracy.
UNASSIGNED: Adult patients with moderate-to-severe or critically ill COVID-19 infection were included in this study. Serum samples were collected at the time of diagnosis for fasting plasma glucose, serum insulin, serum cortisol, and serum glucagon measurements, and the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score was calculated.
UNASSIGNED: One hundred and twenty-six subjects with a mean (standard deviation) age of 49.6 (16.3) years were recruited in this study, and 62.4% (78 of 125 patients) were male. HOMA-IR was a predictor of inhospital mortality with the area under the receiver operating characteristics curve (AUROC) (95% confidence interval [CI] of 0.61 [0.49-0.73]). With a cutoff value of 1.91, sensitivity was 75.5% and specificity was 45.2%. Higher serum insulin was associated with higher survival with AUROC (95% CI) of 0.65 (0.53-0.76), and the best cutoff was 7.15, with a sensitivity and specificity of 62.1% and 64.5%. Serum cortisol was also a predictor of inhospital mortality with an AUROC (95% CI) of 0.67 (0.56-0.77).
UNASSIGNED: An independent association between baseline serum cortisol and poor outcome in moderate-to-severe COVID-19 patients was observed. Hyperglycemia and HOMA-IR can also predict poor outcome in these patients with some accuracy.
摘要：
胰岛素抵抗通常被认为是脓毒症患者细胞介导的免疫功能障碍的危险因素，并导致不良的临床结果。然而,目前尚不清楚2019年冠状病毒病(COVID-19)患者早期胰岛素抵抗是否导致T细胞功能障碍和不良临床结局.
■本研究包括患有中重度或危重COVID-19感染的成年患者。在诊断空腹血糖时收集血清样本，血清胰岛素，血清皮质醇,和血清胰高血糖素测量，并计算胰岛素抵抗稳态模型评估（HOMA-IR）评分。
■这项研究招募了126名平均（标准差）年龄为49.6（16.3）岁的受试者，62.4%(125例患者中的78例)为男性。HOMA-IR是住院死亡率的预测因子，受试者工作特征曲线下面积（AUROC）（95%置信区间[CI]为0.61[0.49-0.73]）。截断值为1.91，灵敏度为75.5％，特异性为45.2％。较高的血清胰岛素与AUROC（95％CI）为0.65（0.53-0.76）的较高生存率相关，最佳截断值为7.15，敏感性和特异性分别为62.1％和64.5％。血清皮质醇也是住院死亡率的预测因子，AUROC（95％CI）为0.67（0.56-0.77）。
■观察到中重度COVID-19患者的基线血清皮质醇与不良预后之间的独立关联。高血糖和HOMA-IR也可以以一定的准确性预测这些患者的不良预后。
■本研究包括患有中重度或危重COVID-19感染的成年患者。在诊断空腹血糖时收集血清样本，血清胰岛素，血清皮质醇,和血清胰高血糖素测量，并计算胰岛素抵抗稳态模型评估（HOMA-IR）评分。
■这项研究招募了126名平均（标准差）年龄为49.6（16.3）岁的受试者，62.4%(125例患者中的78例)为男性。HOMA-IR是住院死亡率的预测因子，受试者工作特征曲线下面积（AUROC）（95%置信区间[CI]为0.61[0.49-0.73]）。截断值为1.91，灵敏度为75.5％，特异性为45.2％。较高的血清胰岛素与AUROC（95％CI）为0.65（0.53-0.76）的较高生存率相关，最佳截断值为7.15，敏感性和特异性分别为62.1％和64.5％。血清皮质醇也是住院死亡率的预测因子，AUROC（95％CI）为0.67（0.56-0.77）。
■观察到中重度COVID-19患者的基线血清皮质醇与不良预后之间的独立关联。高血糖和HOMA-IR也可以以一定的准确性预测这些患者的不良预后。
