title: GLP-1 Levels Predict Mortality in Patients with Critical Illness as Well as End-Stage Renal Disease.
abstract: Glucagon-like peptide 1 (GLP-1) is an incretin hormone, which stimulates glucose-dependent insulin secretion from the pancreas and holds immune-regulatory properties. A marked increase of GLP-1 has been found in critically ill patients. This study was performed to elucidate the underlying mechanism and evaluate its prognostic value.
  
  
  
  GLP-1 plasma levels were determined in 3 different patient cohorts: 1) critically ill patients admitted to our intensive care unit (n = 215); 2) patients with chronic kidney disease on hemodialysis (n = 173); and 3) a control group (no kidney disease, no acute inflammation, n = 105). In vitro experiments were performed to evaluate GLP-1 secretion in response to human serum samples from the above-described cohorts.
  
  
  
  Critically ill patients presented with 6.35-fold higher GLP-1 plasma level in comparison with the control group. There was a significant correlation of GLP-1 levels with markers for the severity of inflammation, but also kidney function. Patients with end-stage renal disease displayed 4.46-fold higher GLP-1 concentrations in comparison with the control group. In vitro experiments revealed a strong GLP-1-inducing potential of serum from critically ill patients, while serum from hemodialysis patients only modestly increased GLP-1 secretion. GLP-1 levels independently predicted mortality in critically ill patients and patients with end-stage renal disease.
  
  
  
  Chronic and acute inflammatory processes like sepsis or chronic kidney disease increase circulating GLP-1 levels. This most likely reflects a sum effect of increased GLP-1 secretion and decreased GLP-1 clearance. GLP-1 plasma levels independently predict the outcome of critically ill and end-stage renal disease patients.
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany.
authors.forename: Corinna
authors.initials: C
authors.lastname: Lebherz
authors.affiliation: Department of Internal Medicine II, University Hospital Aachen, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Schlieper
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Möllmann
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Kahles
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany.
authors.forename: Marvin
authors.initials: M
authors.lastname: Schwarz
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Brünsing
authors.affiliation: Center for Renal Diseases, Zvezdara University, Medical Center, Belgrade, Serbia.
authors.forename: Nada
authors.initials: N
authors.lastname: Dimkovic
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Koch
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.affiliation: Department of Internal Medicine II, University Hospital Aachen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Flöge
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany.
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Marx
authors.affiliation: Department of Internal Medicine III, University Hospital Aachen, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.affiliation: Department of Internal Medicine I, University Hospital Aachen, Germany. Electronic address: mlehrke@ukaachen.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Lehrke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D003422:Critical Care; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000097:blood* / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D018805:Sepsis / Q000097:blood / Q000401:mortality / Q000628:therapy; D055815:Young Adult
chemical_list: D015415:Biomarkers; D052216:Glucagon-Like Peptide 1
keywords: CKD; Chronic kidney disease; Critically ill; GLP-1; Hemodialysis; Inflammation; Kidney function; Mortality; Prognosis; Sepsis