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.
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