Variations in insulin requirements can be an early indicator of sepsis in burn patients

Abstract

IntroductionA >25% increase in daily insulin dosing is suggestive of possible sepsis in burn patients, however, no conclusive evidence is available regarding the time point at which insulin dosing begins to increase. The purpose of this study is to determine the exact time point at which the insulin requirement increases among non-diabetic burn patients with sepsis. MethodsA retrospective chart review in non-diabetic burn patients with ≥20% total body surface area burned (TBSA) during 2010–2018 who received a blood culture for suspected sepsis. Absolute insulin dosing at intervals (0, 24, 48, 72, and 96 h prior to blood culture) were Box–Cox transformed and compared vs.−96 h reference using mixed-effects models accounting for within-patient dependencies. ResultsFifty-eight patients (84% males, age 44 ± 17 years, TBSA% 49 ± 17.5) were included. When cube root of daily insulin dosing was regressed on each time point in a mixed-effects model, statistically significant increase in insulin dosing compared to baseline was observed for −48 (p = 0.018), −24 (p = 0.011), and 0 h (p = 0.008). ConclusionDaily insulin dosing increases 48 h prior to development of other clinical signs of sepsis and can be used as a sensitive early marker.