Abstract
IntroductionLeptin (LEP) and its receptor (LEPR) participate in the immunological response during infection. LEP serum levels rise during sepsis. In patients with peritonitis, an insufficient elevation in serum LEP is associated with an increased risk of death. As gene variants of LEP and LEPR have been associated with diverse pathologic conditions, we explored the association of genetic polymorphisms of LEP or LEPR with death in patients with secondary peritonitis.MethodsA case control study was undertaken. LEP Gene -2548G > A and the LEPR Gene 223A > G polymorphism were determined in 74 patients. The odds ratio of genotype and allele distribution in survival (control) versus death (case) among patients was calculated. Serum LEP, interleukin (IL)-6, tumour necrosis factor alpha, C-reactive protein (C-RP), IL-10 and IL-13 levels were analyzed in 34 patients.ResultsThere were significant differences in genotype and allele distribution between survivors and non-survivors for -2548G > A and 223A > G polymorphisms. The presence of the mutant allele A, in -2548, had an odds ratio of 4.64 (95% CI 1.22, 17.67) with significance (P = 0.017) in the risk of death. The presence of mutant allele G, in 223, had an odds ratio of 3.57 (95% CI 1.06, 12.01) with significance in the risk of death (P = 0.033). The presence of allele A in the -2548 polymorphism was associated with differences in serum LEP (P = 0.013), and IL-10 (P = 0.0001). The presence of allele G in 223 polymorphism was likewise correlated with differences in serum LEP (P < 0001), C-RP (P = 0.033), and IL-10 (P = 0.043).ConclusionsThe polymorphisms studied are associated with death in patients with peritonitis of non-appendicular origin. This association is stronger than many known risk-factors related to peritonitis severity, and is independent of body mass. The physiopathologic mechanism is possibly related to an insufficient increase in the elevation of serum LEP levels, and is unrelated to body mass.
Highlights
Leptin (LEP) and its receptor (LEPR) participate in the immunological response during infection
The presence of allele A in the -2548 polymorphism was associated with differences in serum LEP (P = 0.013), and IL-10 (P = 0.0001)
The presence of allele G in 223 polymorphism was likewise correlated with differences in serum LEP (P < 0001), C-reactive protein (C-RP) (P = 0.033), and IL-10 (P = 0.043)
Summary
Leptin (LEP) and its receptor (LEPR) participate in the immunological response during infection. An insufficient elevation in serum LEP is associated with an increased risk of death. Leptin (LEP) is a cytokine-like hormone that is primarily synthesized and secreted by white adipose tissue. As a hormone it has important functions in the regulation of body weight, reproduction, immune functions, bone formation and growth [1]. LEP and LEPR participate in the immunological response during infection. In surgically treated patients with peritonitis, an insufficient rise in serum LEP (< 10 ng/mL) is associated with a threefold-increase in the risk of death (sensitivity 94.4, specificity 50%) [8]
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