Adiponectin, retinol-binding protein 4, and leptin in protracted critical illness of pulmonary origin.
BACKGROUND
Critically ill patients requiring intensive care uniformly develop insulin resistance. This is most pronounced in patients with sepsis. Recently, several hormones secreted by adipose tissue have been identified to be involved in overall insulin sensitivity in metabolic syndrome-related conditions. However, little is known about these adipokines in critical illness.


METHODS
We studied circulating levels of the adipokines adiponectin, retinol-binding protein 4 (RBP4), and leptin during critical illness, and the impact of intensive insulin therapy, a therapy shown to affect insulin sensitivity, in serum samples from prolonged critically ill patients with a respiratory critical illness (n = 318). For comparison, we studied healthy subjects (n = 22) and acutely stressed patients (n = 22).


RESULTS
During acute critical illness, circulating levels of adiponectin, RBP4, and leptin were low. Patients with sepsis had lower levels of leptin and RBP4 than did nonseptic patients. When critical illness was sustained, adipokine levels returned to normal reference values. Insulin therapy enhanced adiponectin, blunted the rise of RBP4, and did not alter leptin levels.


CONCLUSIONS
Acute critical illness is associated with immediate, but transiently low serum adipokine levels. Adiponectin and RBP4 are associated with altered insulin resistance in critical illness.
Langouche
Lies
L
Department of Intensive Care Medicine, Katholieke Universiteit Leuven, Herestraat 49, 3000 Leuven, Belgium. lies.langouche@med.kuleuven.be
Vander Perre
Sarah
S
Frystyk
Jan
J
Flyvbjerg
Allan
A
Hansen
Troels Krarup
TK
Van den Berghe
Greet
G
D052242:Adiponectin / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D016638:Critical Illness; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood*; D008171:Lung Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D054839:Retinol-Binding Proteins, Plasma / Q000378:metabolism*
D052242:Adiponectin; D020738:Leptin; C101326:RBP4 protein, human; D054839:Retinol-Binding Proteins, Plasma