title: Obesity and pro-inflammatory mediators are associated with acute kidney injury in patients with A/H1N1 influenza and acute respiratory distress syndrome.
abstract: BACKGROUND
  The obesity has been shown to increase the severity of A/H1N1 infection and the development of acute respiratory distress syndrome (ARDS) and organ involvement.
  
  
  METHODS
  Circulating levels of C-peptide, insulin, glucagon, leptin, acute phase reactants (procalcitonin, C-reactive protein, tissue plasminogen activator, and serum amyloids A and P), were measured in samples from 32 critically ill patients with A/H1N1 virus infection, 17 of whom had ARDS complicated by acute kidney injury (AKI) and 15 of whom had ARDS but did not develop AKI.
  
  
  RESULTS
  Patients with ARDS and AKI (ARDS/AKI) had higher BMI and higher levels of C-peptide, insulin, leptin, procalcitonin and serum amyloid A compared to those ARDS patient who did not develop AKI. Adjusting for confounding variables using logistic regression analysis, higher levels of C-peptide (>0.75 ng/mL) (OR=64.8, 95% CI = 2.1-1980, p = 0.0006) and BMI>30 Kg/m(2) (OR = 42.0, 95% CI = 1.2-1478, p = 0.04) were significantly associated with the development of AKI in ARDS patients.
  
  
  CONCLUSIONS
  High levels of C-peptide and BMI>30 kg/m(2) were associated with the development of AKI in ARDS patients due to A/H1N1 infection. These metabolic/obesity indicators, together with the profiles of pro-inflammatory acute phase proteins, may be important links between obesity and poor outcomes in A/H1N1 09 infection.
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cruz-Lagunas
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Luís
authors.initials: L
authors.lastname: Jiménez-Alvarez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Ramírez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico. Electronic address: criselda.mendoza@gmail.com.
authors.forename: Criselda
authors.initials: C
authors.lastname: Mendoza-Milla
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Ma Cecilia
authors.initials: MC
authors.lastname: García-Sancho
authors.affiliation: Universidad Nacional Autonóma de México, UNAM; FES-Iztacala, Unidad de Biomedicina, UBIMED, Mexico City, Mexico.
authors.forename: Federico
authors.initials: F
authors.lastname: Avila-Moreno
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Pedro
authors.initials: P
authors.lastname: Zamudio
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Francisco
authors.initials: F
authors.lastname: Urrea
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Blanca
authors.initials: B
authors.lastname: Ortiz-Quintero
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Campos-Toscuento
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Juan
authors.initials: J
authors.lastname: Morán
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Aldo A
authors.initials: AA
authors.lastname: Barrera
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Martínez-Briseño
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Rosario
authors.initials: R
authors.lastname: Fernández-Plata
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Martha Patricia
authors.initials: MP
authors.lastname: Sierra-Vargas
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Carolina
authors.initials: C
authors.lastname: Muñoz-Perea
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Samuel
authors.initials: S
authors.lastname: Illescas-Flores
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: Edgar
authors.initials: E
authors.lastname: Bautista
authors.affiliation: Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Suratt
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
authors.forename: José Rogelio
authors.initials: JR
authors.lastname: Pérez-Padilla
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico. Electronic address: joazu@yahoo.com.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Zuñiga
mesh_terms: D058186:Acute Kidney Injury / Q000378:metabolism / Q000821:virology*; D000328:Adult; D016638:Critical Illness; D005260:Female; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications*; D012128:Respiratory Distress Syndrome / Q000378:metabolism / Q000821:virology*
keywords: A/H1N1 influenza infection; AKI; Acute kidney injury; C-peptide; Insulin; Leptin