Iinsulin Levels and Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) May Explain a Possible Important Role of the Pancreas In Sickle Cell Disease Patients Outcome

Abstract 4811

Sickle cell disease (SCD) is a hematological disorder characterized by the S hemoglobin homozygosis or the association with others variants of hemoglobin. The SCD is characterized by heterogeneous clinical outcome compound by hemolysis, chronic inflammation and vaso-oclusive and pain episodes. Red Blood cell (RBC) count, hemoglobin concentration (HB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), total bilirrubin (BT) and indirect bilirrubin (BI) are important biomarkers in SCD patients follow-up. The insulin are essential for regulation and maintenance of glucose homeostasis and the insulin resistance are associated with chronic sub-clinical inflammation and inflammatory markers such as C - reactive protein (CRP) and white blood cells (WBC) count. These markers have been correlated with the severity of SCD. The aim of this study was investigate insulin levels and HOMA-IR in SCD and it correlation with important biomarkers. Here we developed a cross sectional study involving 40 SCD patients in the steady-state of disease aging 13.9+ 8.23 years old. The RBC and WBC count were carried out by automated method and the levels of BT, BI, AST, LDH and insulin levels were investigated by immunochemistry assay method. The mean of insulin levels was 3.2 ± 2.2 and HOMA-IR was 0.61 ± 0.46. SCD patients with insulin levels lowest than the mean had an increase levels of AST (p<0.001), BT (p=0.004), BI (p=0.008), LDH (p=0.005) and WBC count (p=0.005) and decrease of HB concentration (p=0.026), HOMA-RI (p=0.001) and RBC count (p=0.006). When we studied the 25^th percentile a low insulin level was correlated with high ferritin concentration (p=0.019) and in 75^th percentile high insulin levels were associated with high haptoglobin concentration (p=0.024), outside difference above described. Insulin levels were negatively associated with reticulocyte (p=0.0001, r= -0.5762; BT (p=0.0003, r= -0.5444), BI (p= 0.0017, r= -0.4856) and LDH (p=0.0018 r= -0.4833). In this study the HOMA-IR was used for evaluation of insulin resistance. HOMA-IR was negatively associated with WBC count (p=0.0039, r= -0.4465); reticulocyte count (p=0.0002, r= -0.5582); BT (p= 0.0012, r= -0.4885); BI (p=0.0101, r= -0.4074) e LDH (p=0.0094 r= -0.4108. Ours results demonstrate that levels of insulin and of HOMA-IR can be influenced by the oxidative stress and inflammation secondarily of the intravascular and extravascular hemolysis in sickle cell disease, suggesting an important role of these biomarkers in the disease pathogenesis. Additional studies are warranted to explain the contribution of the pancreas in the complex net of biomarkers alteration in the disease.