Abstract
The objective of this study was to evaluate leptin, ghrelin, and leptin/ghrelin ratio in critically ill patients and association of leptin/ghrelin ratio with outcomes. This is a sub-study of the PermiT trial (ISRCTN68144998). A subset of 72 patients who were expected to stay >14 days in the Intensive care unit were enrolled. Blood samples were collected on days 1, 3, 5, 7, and 14. Samples were analyzed for leptin and active ghrelin in addition to other hormones. Baseline leptin/ghrelin ratio was calculated, and patients were stratified into low and high leptin/ghrelin ratio based on the median value of 236. There was a considerable variation in baseline leptin level: Median 5.22 ng/mL (Q1, Q3: 1.26, 17.60). Ghrelin level was generally low: 10.61 pg/mL (Q1, Q3: 8.62, 25.36). Patients with high leptin/ghrelin ratio compared to patients with low leptin/ghrelin ratio were older, had higher body mass index and more likely to be diabetic. There were no differences in leptin/ghrelin ratio between patients who received permissive underfeeding and standard feeding. Multivariable logistic regression analysis showed that age and body mass index were significant independent predictors of high leptin–ghrelin ratio. Leptin–ghrelin ratio was not associated with 90-day mortality or other outcomes. Age and body mass index are predictors of high leptin/ghrelin ratio. Leptin/ghrelin ratio is not affected by permissive underfeeding and is not associated with mortality.
Highlights
Leptin and ghrelin are two orexitropic hormones with opposite effects on energy homeostasis.Leptin is an adipokine that is released by the adipose tissue
More patients in the high leptin–ghrelin ratio group were more likely to be on aspirin and statins in comparison to the low leptin–ghrelin ratio group (16 (44.4%) vs. 7 (19.4%), p = 0.02 and 19 (52.8%) vs
In this cohort of critically ill patients, we found large variations in leptin levels while active ghrelin levels were low
Summary
Leptin and ghrelin are two orexitropic hormones with opposite effects on energy homeostasis. Leptin is an adipokine that is released by the adipose tissue. It regulates food intake and energy expenditure and suppresses appetite (satiety hormone) by sending signals about the peripheral obesity to the central nervous system [1]. Leptin has other effects on glucose homeostasis, immune response, growth and differentiation and angiogenesis and have been implicated in the pathogenesis. Ghrelin is secreted in the stomach [6], and is a potent appetite stimulator (hunger hormone). A study showed that ghrelin levels are reduced in intensive care unit (ICU) patients which seemed to be responsible for suppression of appetite and nutritional intake and gastrointestinal dysfunction including delayed gastric emptying [14]
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