Abstract
The adipocyte-derived cytokine leptin was implicated to link inflammation and metabolic alterations. We investigated the potential role of leptin components in critically ill patients, because systemic inflammation, insulin resistance, and hyperglycemia are common features of critical illness. Upon admission to Medical Intensive Care Unit (ICU), free leptin and soluble leptin-receptor serum concentrations were determined in 137 critically ill patients (95 with sepsis, 42 without sepsis) and 26 healthy controls. Serum leptin or leptin-receptor did not differ between patients or controls and were independent of sepsis. However, serum leptin was closely associated with obesity and diabetes and clearly correlated with markers of metabolism and liver function. Leptin-receptor was an unfavourable prognostic indicator, associated with mortality during three years follow-up. Our study indicates a functional role of leptin in the pathogenesis of severe illness and emphasizes the impact of complex metabolic alterations on the clinical outcome of critically ill patients.
Highlights
Hyperglycemia, glucose intolerance, and insulin resistance are common features of critically ill patients, especially in patients with sepsis or septic shock, even in those without preexisting diabetes mellitus [1,2,3]
We investigated the potential role of leptin components in critically ill patients, because systemic inflammation, insulin resistance, and hyperglycemia are common features of critical illness
Our study indicates a functional role of leptin in the pathogenesis of severe illness and emphasizes the impact of complex metabolic alterations on the clinical outcome of critically ill patients
Summary
Hyperglycemia, glucose intolerance, and insulin resistance are common features of critically ill patients, especially in patients with sepsis or septic shock, even in those without preexisting diabetes mellitus [1,2,3]. Metabolic syndrome, and type 2 diabetes, several adipocytokines have been identified that mediate agonistic and antagonistic effects on insulin resistance [4, 5]. A link between adipocytokines, inflammation, and systemic insulin resistance has been established in obese and diabetic patients [5]. Little is known about the actions of the different adipokines, especially about their potential impact on insulin resistance. Leptin exerts its various actions on glucose metabolism and energy expenditure via binding to the leptin-receptor in the brain and peripheral tissues as pancreas, liver, adipose tissue, and in the immune system [12]. Various animal and human studies have shown that administration of endotoxin, TNFα, and other cytokines as inducers of severe systemic inflammation result in a significant elevation of serum leptin concentrations [14, 15]
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