A leptin serum concentration less than 10 ng/ml is a predictive marker of outcome in patients with moderate to severe secondary peritonitis.
BACKGROUND
Leptin is involved in the sepsis syndrome. A possible relationship exists between low leptin levels and peritonitis severity and a poorer prognosis.


OBJECTIVE
We aimed to corroborate the relationship between low leptin serum levels and death in patients with peritonitis and to explore the associations between leptin and interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-13 (IL-13), tumor necrosis factor-alpha (TNF-alpha) and C-reactive protein (CRP).


METHODS
In 230 adult patients with surgically confirmed secondary peritonitis, the Mannheim Peritonitis Index and the serum concentrations of leptin, IL-6, IL-10, IL-13, TNF-alpha and CRP were determined. Two cohorts were established (leptin < or = 10 ng/ml and > 10 ng/ml). Death or survival was followed through 30 days. The relationship between leptin (< or = 10 ng/ml) and death was evaluated using the accumulated incidence ratio (AIR). The association of leptin (dependent variable) with IL-6, IL-10, IL-13, TNF-alpha and CRP (independent variables) was studied by regression analysis.


RESULTS
The general mortality rate was 7.8% and the death AIR was 3.15 (p nonsignificant). A subsample of patients with a Mannheim Peritonitis Index > or = 21 was studied, showing a significant AIR of 4.26 (p = 0.017). Regression analysis determined an association only between leptin and IL-6 (p < 0.001), IL-10 (p < 0.047) and CRP (p < 0.001).


CONCLUSIONS
A serum leptin below the threshold of 10 ng/ml is an adverse prognostic marker in patients with moderate to severe secondary peritonitis. The results of the regression analysis suggest that the mechanisms involved are opposing, in that leptin associated with IL-6 has a proinflammatory effect and, through IL-10 and CRP production, restrains the inflammatory response.
Departamento de Posgrado e Investigación, Facultad de Medicina, Universidad Juárez del Estado de Durango, Durango, Mexico. rudybracho@yahoo.com.mx
R L
RL
Bracho-Riquelme
M A
MA
Reyes-Romero
N
N
Pescador
A I
AI
Flores-García
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D016753:Interleukin-10 / Q000097:blood; D018793:Interleukin-13 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D020738:Leptin / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000097:blood* / Q000276:immunology / Q000401:mortality*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D015415:Biomarkers; C508609:IL10 protein, human; C508600:IL6 protein, human; D018793:Interleukin-13; D015850:Interleukin-6; D020738:Leptin; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002097:C-Reactive Protein