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Serum adipocyte fatty acid-binding protein levels in patients with critical illness are associated with insulin resistance and predict mortality

Chi-Lun Huang123, Yen-Wen Wu2456, Ai-Ru Hsieh7, Yu-Hsuan Hung3, Wen-Jone Chen28* and Wei-Shiung Yang23*

Author Affiliations

1 Department of Internal Medicine, Taoyuan General Hospital, 1492 Chung-Shan Rd., Taoyuan City 33004, Taiwan

2 Department of Internal Medicine, National Taiwan University Hospital, 7 Chung Shan S. Rd., Taipei City 10002, Taiwan

3 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, 7 Chung Shan S. Rd., Taipei City 10002, Taiwan

4 Department of Nuclear Medicine, National Taiwan University Hospital, 7 Chung Shan S. Rd., Taipei City 10002, Taiwan

5 Department of Nuclear Medicine and Cardiovascular Medical Center (Cardiology), Far Eastern Memorial Hospital, 21 Nanya S. Rd. Sec. 2, New Taipei City 22060, Taiwan

6 National Yang-Ming University School of Medicine, 155 Li-Nong St. Sec. 2, Taipei City 11221, Taiwan

7 Institute of Biomedical Science, Academia Sinica, 128 Academia Rd. Sec. 2, Taipei City 11529, Taiwan

8 Department of Emergency Medicine, National Taiwan University Hospital, 7 Chung Shan S. Rd., Taipei City 10002, Taiwan

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Critical Care 2013, 17:R22  doi:10.1186/cc12498

See related commentary by Das,

Published: 1 February 2013



Hyperglycemia and insulin resistance are commonplace in critical illness, especially in patients with sepsis. Recently, several hormones secreted by adipose tissue have been determined to be involved in overall insulin sensitivity in metabolic syndrome-related conditions, including adipocyte fatty-acid binding protein (A-FABP). However, little is known about their roles in critical illness. On the other hand, there is evidence that several adipose tissue gene expressions change in critically ill patients.


A total of 120 patients (72 with sepsis, 48 without sepsis) were studied prospectively on admission to a medical ICU and compared with 45 healthy volunteers as controls. Various laboratory parameters and metabolic and inflammatory profiles were assessed within 48 hours after admission. Clinical data were collected from medical records.


Compared with healthy controls, serum A-FABP concentrations were higher in all critically ill patients, and there was a trend of higher A-FABP in patients with sepsis. In multivariate correlation analysis in all critically ill patients, the serum A-FABP concentrations were independently related to serum creatinine, fasting plasma glucose, total cholesterol, TNF-alpha, albumin, and the Acute Physiology and Chronic Health Evaluation II scores. In survival analysis, higher A-FABP levels (> 40 ng/ml) were associated with an unfavorable overall survival outcome, especially in sepsis patients.


Critically ill patients have higher serum A-FABP concentrations. Moreover, A-FABP may potentially serve as a prognostic biomarker in critically ill patients with sepsis.