Are Adiponectin and Insulin Resistance Related to Stress Hyperglycaemia in Critically Ill Patients?

Stress hyperglycaemia (SH) is frequent in critical illness, increases morbidity and mortality and is strongly associated with acute kidney injury (AKI). It remains unanswered whether insulin resistance or decreased adiponectin contribute to SH as they do to chronic hyperglycaemia. Our aims were to identify potential relationships between insulin resistance, serum high molecular weight (HMW) adiponectin and SH, while controlling for and excluding other risk factors and confounders of both SH and chronic hyperglycaemia such as diabetes, as well as potential relationships between HMW-adiponectin and subsequent AKI. We studied 158 critically ill patients admitted to intensive care units. SH was defined by blood glucose > 140 mg/dl, insulin resistance as Homeostasis model assessment-2-scores above the 75th percentile, decreased HMW-adiponectin as values below the 25th percentile, and AKI by Kidney-Disease-Improving-Global-Outcomes criteria. Seventy-seven patients (48.7%) featured SH. Patients with and without SH were well balanced in regard to most factors causing chronic hyperglycaemia. The SH group had substantially higher HOMA-2-scores and lower serum HMW-adiponectin levels. Adjusted to risk factors of SH and chronic hyperglycaemia, both insulin resistance and decreased serum HMW-adiponectin levels were independently and strongly related to SH (adjusted odds ratios 7.24 (95% confidence interval 3.17–19.01) and 3.10 (95% confidence interval 1.61–5.47), respectively). In the subgroups of SH and non-SH patients without AKI, HMW-adiponectin was significantly higher. In conclusion, insulin resistance and decreased HMW-adiponectin may be risk factors of SH in critically ill patients. In addition, elevated serum HMW-adiponectin may attenuate AKI irrespective of SH.