Retrospective study of 77 HTGP patients (pt) to evaluate triglyceride (TG) response to continuous insulin infusion (CII) given in ICU using 0.1 U/kg. Median age 40 (IQR 32-45) y, 66% male, 58% Hispanic, 51% alcohol use, 74% diabetes (DM), A1c 9.5 (6-12) %, initial TG 3869 (2714-5444) mg/dl. TG goal (1000 ± 100 or less) achieved in 95% (Responder=R). The 4 pt not reaching TG goal had longer time from initial TG to CII start, 10 (2-37) vs. 3 (3-5.5) hours (h), and higher insulin needs 5.4 (1.3-6.5) vs. 1.9 (0.9-3.6) U/kg. In 73 R, time points to reach TG goal in Figure 1. R reaching TG goal in < 36 (49%) vs. >36 h had lower initial TG 2788 (1819-4486) vs. 4836 (3408-7053), A1C 6.7 (5.6-10.7) vs. 10.7 (8.4-12.7), BMI 28.7 (25-33) vs. 31.5 (28-37), insulin needs 0.92 (0.46-1.8) vs. 2.92 (2.0-4.7) and reached TG 50% (≤50% baseline TG) faster 13 (6-17) vs. 16 (12-32). Among R, DM (74%) vs. non-DM pt had higher initial TG 3990 (2859-6150) vs. 3512 (2142-4519), BMI 31.5 (28-36) vs. 27.7 (24-30), insulin needs 2.4 (1.3-3.8) vs. 0.82 (0.4-1.5) and took longer to reach TG 50% 16 (11-27) vs. 10 (5-15) and final TG 40 (25-57) vs. 15 (14-26). In multivariate analysis, quick TG response predictors were no DM, low initial TG, A1C. All results significant. CII was effective in reaching TG goal in 95% of pt, most within 2 days. Study suggests need for higher insulin dose in pt with late response predictors. Rate of TG 50% decline may be a real time indicator to adjust insulin rate for quicker response.
V. Pulipati: None. A. Amblee: None. S.T. Yap: None. H. Shaka: None. L. Fogelfeld: Research Support; Self; Bayer Healthcare Pharmaceuticals Inc., Gan & Lee Pharmaceuticals, Gilead Sciences, Inc., Merck & Co., Inc., Sanofi.
