Serum Leptin Levels, Nutritional Status, and the Risk of Healthcare-Associated Infections in Hospitalized Older Adults.

Elena Paillaud,Catherine Conti,Johanne Poisson,Sylvie Bastuji-Garin,Agathe Raynaud-Simon,Antonin Ginguay,Amaury Broussier,Anne Plonquet,Clemence Granier

doi:10.3390/nu14010226

Abstract

We aimed to determine whether serum leptin levels are predictive of the occurrence of healthcare-associated infections (HAIs) in hospitalized older patients. In a prospective cohort, 232 patients had available data for leptin and were monitored for HAIs for 3 months. Admission data included comorbidities, invasive procedures, the Mini Nutritional Assessment (MNA), BMI, leptin, albumin and C-reactive protein levels, and CD4 and CD8 T-cell counts. Multivariate logistic regression modelling was used to identify predictors of HAIs. Of the 232 patients (median age: 84.8; females: 72.4%), 89 (38.4%) experienced HAIs. The leptin level was associated with the BMI (p < 0.0001) and MNA (p < 0.0001) categories. Women who experienced HAIs had significantly lower leptin levels than those who did not (5.9 μg/L (2.6–17.7) and 11.8 (4.6–26.3), respectively; p = 0.01; odds ratio (OR) (95% confidence interval): 0.67 (0.49–0.90)); no such association was observed for men. In a multivariate analysis of the women, a lower leptin level was significantly associated with HAIs (OR = 0.70 (0.49–0.97)), independently of comorbidities, invasive medical procedures, and immune status. However, leptin was not significantly associated with HAIs after adjustments for malnutrition (p = 0.26) or albuminemia (p = 0.15)—suggesting that in older women, the association between serum leptin levels and subsequent HAIs is mediated by nutritional status.

Highlights

We have reported previously that in older patients admitted to a rehabilitation care facility, subsequent healthcare-associated infection (HAI) were associated with lower baseline values for energy intake and serum albumin, independently of immune variables [14]
The objectives of the present study were to investigate the relationship between leptin levels and nutritional variables in older patients hospitalized in rehabilitation unit, and to determine whether lower leptin levels were associated with HAIs
In multivariate analyses (Table 4), Model 1 showed that a lower leptin level was significantly associated with HAIs, independently of the immune status, the CIRS-G

Summary

Introduction

The hormone leptin is secreted by adipocytes and regulates food intake and thermogenesis [1]. Some studies [3,4,5,6] (but not others [7]) have observed an association between low leptin levels and malnutrition in patients with severe chronic diseases (such as kidney failure and cirrhosis), independently of the level of inflammation or the fluid balance. A growing body of evidence suggests that leptin can regulate immune function [8] (especially T lymphocyte function [9,10]) and may be involved in the 4.0/). The value of leptin for predicting healthcare-associated infections (HAIs) in older inpatients remains to be determined

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Conclusion