Insulin decreases hepatic acute phase protein levels in severely burned children

Background. Severe burn induces the hepatic acute phase response. In this study, we wondered whether continuous insulin treatment decreases acute phase protein levels in the severely burned. Methods. Eighteen children aged 2 to 17 years with burns >40% of total body surface area were randomized to receive either insulin (n = 9) or no treatment (n = 9) within 72 hours after injury until the wounds were 95% healed. Insulin was given at a continuous rate of ≥ 1.5 μU/kg/min to maintain euglycemia (serum glucose 100-140 μg/dL). Plasma was examined at days 7, 14, 21, and 28 for acute phase protein levels including C-reactive protein, C3 complement, α₁-acid glycoprotein, haptoglobin, α₂-macroglobulin, prealbumin, transferrin, and retinal-binding protein. Statistical analysis was by ANOVA and t test. Results. With insulin treatment, α₁-acid glycoprotein, C3 complement, α₂-macroglobulin, and haptoglobin levels decreased (P < .05) after a severe burn compared with control, especially at days 21 and 28. Additionally, the hepatic constitutive proteins (prealbumin, transferrin, and retinal-binding protein) were lower in the insulin-treatment group than those of the control group at day 21 (P < .05). Conclusions. Continuous insulin treatment decreases acute phase protein levels after a severe burn. The results suggest insulin downregulation of the hepatic acute phase response to injury.