Serum kinetics of total leptin and soluble leptin receptor as prognostic tools in sepsis

Abstract

Introduction: Studies have shown that serum leptin concentrations are altered in sepsis. However, very few prospective studies have investigated its kinetics while the soluble leptin receptor (sOB-R) and its kinetics have not been studied.

Aim: To investigate kinetics of leptin and sOB-R in sepsis and their association with sepsis severity and prognosis.

Methods: We prospectively studied 102 critically ill septic patients (57 males, mean age 65±15years, 60 with sepsis/42 with septic shock). Serum total leptin and sOB-R concentrations were determined by ELISA (BioVendor Laboratory Medicine Inc, Brno, Czech Republic) at sepsis onset and one week after. Statistical analysis was performed using IBM-SPSS® v. 24.

Results: Mean APACHE II was 23±7 and SOFA 10±3. Mortality within 28 days was 29.4%. Leptin and sOB-R significantly decreased during the first week in all patients, with a more pronounced decrease in sepsis compared to septic shock (p<0.001 and p=0.002 respectively) and in survivors compared to nonsurvivors (p<0.001). Lower kinetics of leptin (but not sOB-R) was found to be marginally significant as a predictor of mortality, in univariate analysis (HR 0.83, 95% CI 0.68-1.013, p=0.067). In multivariate analysis, after adjustment for age, gender, BMI, APACHE II score, presence of septic shock and significant laboratory biomarkers, leptin lower kinetics was independently associated with 28-day mortality, (HR 0.48, 95% CI 0.31-0.75, p=0.001). Leptin exhibited significant positive correlations with APACHE II and SOFA and sOB-R with SOFA.

Conclusion: Serum kinetics of leptin (but not sOB-R) during the first week of sepsis may predict severity and mortality in critically ill patients.