title: Plasma adiponectin and mortality in critically ill subjects with acute respiratory failure.
abstract: OBJECTIVE
  : Adiponectin, an anti-inflammatory cytokine produced by adipose tissue, has been shown to modulate survival in animal models of critical illness. We examined the association between plasma adiponectin and clinical outcomes in critically ill patients with acute respiratory failure.
  
  
  METHODS
  : Secondary analysis of a single-center, randomized controlled trial.
  
  
  METHODS
  : Medical intensive care unit of a university-based, tertiary medical center.
  
  
  METHODS
  : One hundred seventy-five subjects with acute respiratory failure enrolled in randomized, controlled pilot trial of Early versus Delayed Enternal Nutrition (EDEN pilot study).
  
  
  METHODS
  : None.
  
  
  RESULTS
  : Adiponectin measured within 48 hrs of respiratory failure (Apn1) was inversely correlated with body mass index (r=-0.25, p=.007) and was higher in females (median, 12.6 μg/mL; interquartile range, 7.6-17.1) than males (9.45 μg/mL; 6.2-14.2; p=.02). Adiponectin increased at day 6 (Apn1: 11.4 μg/mL [6.6-15.3] vs. Apn6: 14.1 μg/mL [10.3-18.6], p<.001). This increase was significant only in survivors (Δ adiponectin in survivors: 3.9±6 μg/mL, n=80, p<.001 vs. Δ in nonsurvivors: 1.69±4.6 μg/mL, n=14, p=.19). Higher Apn1 was significantly associated with 28-day mortality (odds ratio 1.59 per 5-μg/mL increase; 95% confidence interval 1.15-2.21; p=.006). No measured demographic, clinical, or cytokine covariates, including interleukin-6, interleukin-8, interleukin-10, interleukin-1β, interleukin-12, tumor necrosis factor-α, and interferon-γ, were confounders or effect modifiers of this association between adiponectin and mortality.
  
  
  CONCLUSIONS
  : Independent of measured covariates, increased plasma adiponectin levels measured within 48 hrs of respiratory failure are associated with mortality. This finding suggests that factors derived from adipose tissue play a role in modulating the response to critical illness.
authors.affiliation: Department of Medicine, The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA. alwalkey@bu.edu
authors.forename: Allan J
authors.initials: AJ
authors.lastname: Walkey
authors.forename: Todd W
authors.initials: TW
authors.lastname: Rice
authors.forename: Jason
authors.initials: J
authors.lastname: Konter
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Ouchi
authors.forename: Rei
authors.initials: R
authors.lastname: Shibata
authors.forename: Kenneth
authors.initials: K
authors.lastname: Walsh
authors.forename: Bennett P
authors.initials: BP
authors.lastname: deBoisblanc
authors.forename: Ross
authors.initials: R
authors.lastname: Summer
mesh_terms: D018806:APACHE; D052242:Adiponectin / Q000097:blood*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D016001:Confidence Intervals; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010865:Pilot Projects; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012121:Respiration, Artificial / Q000379:methods; D012128:Respiratory Distress Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D052242:Adiponectin; D015415:Biomarkers