Diagnostic and Prognostic Value of Serum Leptin in Critically Ill Patients with Acute versus Acute-on-Chronic Liver Failure
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Leptin Measurements
2.3. Statistical Analysis
3. Results
3.1. Serum Levels of Leptin Are Elevated in Critically Ill Patients Presenting with Acute Liver Failure
3.2. Low Serum Leptin at ICU Admission Reliably Rules out Acute Liver Failure in Critically Ill Patients with Liver Dysfunction
3.3. Serum Levels of Leptin at ICU Admission Correlate with Body Mass Index, Hemoglobin, Inflammation, and Aminotransferases in Critically Ill Patients with Liver Dysfunction
3.4. Levels of Serum Leptin Are Stable in the Early Stage of Critical Illness in Patients with Liver Disease
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Appendix A.1. Serum Leptin Is Not Predictive for Survival in Critically Ill Patients with Liver Dysfunction
References
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Parameter | dACLD | ACLF | ALF | p |
---|---|---|---|---|
Number, n | 20 | 123 | 17 | |
Sex (female/male), n | 9/11 | 50/73 | 9/8 | 0.612 |
Age, [years] | 59.5 (24–80) | 58 (19–87) | 52 (24–78) | 0.196 |
BMI, [kg/m2] | 23.1 (15.8–41.5) | 27.6 (15.6–62.5) | 25.7 (21.7–47.6) | 0.005 * |
APACHE II score | 16.5 (5–37) | 27 (8–55) | 15 (7–39) | <0.001 * |
SOFA score | 8 (3–15) | 14 (5–20) | 9 (4–18) | <0.001 * |
MELD score | 13 (7–28) | 28 (8–40) | 30 (20–40) | <0.001 * |
Liver transplantation, n (%) | 3 (15.0) | 12 (9.8) | 6 (35.5) | 0.014 * |
Mechanical ventilation, n (%) | 3 (15.0) | 64 (52.0) | 2 (11.8) | <0.001 * |
Vasopressor demand, n (%) | 1 (5.0) | 100 (81.3) | 4 (23.5) | <0.001 * |
ICU days n | 3 (2–15) | 6 (1–178) | 6 (3–39) | <0.001 * |
Death on ICU, n (%) | 0 (0) | 70 (56.9) | 4 (23.5) | <0.001 * |
30-day mortality, n (%) | 0 (0) | 60 (52.6) | 2 (11.8) | <0.001 * |
1-year mortality, n (%) | 3 (15.8) | 76 (67.3) | 5 (31.2) | <0.001 * |
Leptin at ICU admission, [pg/mL] | 50 (0–235) | 29 (0–1000) | 110 (0–1000) | <0.001 * |
Metric | Value (%) |
---|---|
Sensitivity | 94.1 |
Specificity | 67.5 |
PPV | 28.6 |
NPV | 98.8 |
Parameter | Spearman’s r | p |
---|---|---|
Demographics | ||
Age | 0.099 | 0.213 |
Body mass index | 0.289 | <0.001 * |
Blood count and markers of inflammation | ||
Leukocytes | 0.068 | 0.396 |
Hemoglobin | 0.271 | 0.001 * |
Platelets | 0.067 | 0.401 |
C-reactive protein | −0.303 | <0.001 * |
Procalcitonin | −0.109 | 0.191 |
Interleukin 6 | −0.229 | 0.011 * |
Electrolytes and renal system | ||
Sodium | 0.037 | 0.646 |
Potassium | −0.006 | 0.943 |
pH | 0.083 | 0.296 |
Urea | −0.176 | 0.026 * |
Creatinine | −0.134 | 0.091 |
eGFR | 0.117 | 0.142 |
Diuresis per day | 0.092 | 0.258 |
Hepato-pancreatico-biliary system and coagulation | ||
Albumin | 0.143 | 0.072 |
INR | 0.098 | 0.22 |
Bilirubin, total | 0.050 | 0.529 |
AST | 0.210 | 0.008 * |
ALT | 0.258 | 0.001 * |
γGT | 0.046 | 0.567 |
AP | 0.021 | 0.790 |
AFP | 0.125 | 0.553 |
Cholesterol, total | 0.095 | 0.245 |
Triglycerides | 0.048 | 0.552 |
Cardiopulmonary system | ||
NT-proBNP | −0.315 | <0.001 * |
Norepinephrine demand | −0.124 | 0.207 |
Horovitz quotient (PaO2/FiO2) | 0.142 | 0.073 |
FiO2 | −0.127 | 0.11 |
Lactate | 0.289 | <0.001 * |
Disease severity and clinical scores | ||
Length of stay in ICU | 0.077 | 0.331 |
Length of stay in hospital | −0.061 | 0.442 |
SOFA score | −0.078 | 0.329 |
APACHE II score | −0.031 | 0.701 |
SAPS II score | −0.102 | 0.197 |
MELD | 0.047 | 0.553 |
Child-Pugh points | −0.025 | 0.765 |
CLIF-C OF score | −0.116 | 0.178 |
CLIF-C ACLF score | 0.060 | 0.508 |
Univariable Regression | Multivariable Regression | ||||||
---|---|---|---|---|---|---|---|
Covariate | Beta Coefficient | Coefficient | 95% CI | p | Coefficient | 95% CI | p |
BMI | 50.22 | 6.973 | 2.960–10.986 | <0.001 * | 7.278 | 3.018–11.539 | <0.001 * |
Male sex | −24.67 | −49.914 | −109.806–9.978 | 0.102 | |||
Hemoglobin | 56.17 | 24.256 | 11.937–36.576 | <0.001 * | 24.831 | 9.164–40.498 | 0.002 * |
CRP | −41.09 | −0.738 | −1.261–−0.214 | 0.006 * | −0.590 | −1.180–−0.001 | 0.050 |
IL-6 | −5.23 | 0.000 | −0.002–0.001 | 0.778 | |||
Urea | −13.89 | −0.215 | −0.675–0.246 | 0.358 | |||
AST | 35.92 | 0.017 | 0.003–0.031 | 0.017 * | −0.004 | −0.033–0.025 | 0.786 |
ALT | 57.72 | 0.035 | 0.018–0.052 | <0.001 * | 0.019 | −0.016–0.055 | 0.284 |
NT-proBNP | −38.91 | −0.004 | −0.007–−0.001 | 0.026 * | −0.002 | −0.005–0.002 | 0.360 |
Lactate | 21.80 | 6.713 | −2.42–15.85 | 0.149 |
Univariable Regression | Multivariable Regression | |||||
---|---|---|---|---|---|---|
Covariate | Coefficient | 95% CI | p | Coefficient | 95% CI | p |
Diabetes mellitus | 71.1 | 4.1–138.0 | 0.038 * | 77.5 | 11.6–143.4 | 0.021 * |
Hypertension | −38.6 | −103.9–26.7 | 0.245 | |||
Coronary artery disease | −16.3 | −108.6–75.9 | 0.727 | |||
Chronic alcohol consumption | 72.1 | 13.3–130.9 | 0.017 * | 77.1 | 19.0–135.3 | 0.010 * |
Chronic obstructive pulmonary disease | 81.1 | −31.6–193.7 | 0.157 | |||
Malignancy | 79.9 | −7.6–167.5 | 0.073 | |||
Hepatocellular carcinoma | 54.8 | −81.9–191.6 | 0.43 | |||
Hematological neoplasm | 63.5 | −93.4–220.3 | 0.425 | |||
Solid neoplasm | 75.5 | −70.0–221.0 | 0.307 |
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Hohlstein, P.; Salvarcioglu, C.; Pollmanns, M.R.; Adams, J.K.; Abu Jhaisha, S.; Kabak, E.; Eisert, A.; Hamesch, K.; Weiskirchen, R.; Koch, A.; et al. Diagnostic and Prognostic Value of Serum Leptin in Critically Ill Patients with Acute versus Acute-on-Chronic Liver Failure. Biomedicines 2024, 12, 1170. https://doi.org/10.3390/biomedicines12061170
Hohlstein P, Salvarcioglu C, Pollmanns MR, Adams JK, Abu Jhaisha S, Kabak E, Eisert A, Hamesch K, Weiskirchen R, Koch A, et al. Diagnostic and Prognostic Value of Serum Leptin in Critically Ill Patients with Acute versus Acute-on-Chronic Liver Failure. Biomedicines. 2024; 12(6):1170. https://doi.org/10.3390/biomedicines12061170
Chicago/Turabian StyleHohlstein, Philipp, Can Salvarcioglu, Maike R. Pollmanns, Jule K. Adams, Samira Abu Jhaisha, Elena Kabak, Albrecht Eisert, Karim Hamesch, Ralf Weiskirchen, Alexander Koch, and et al. 2024. "Diagnostic and Prognostic Value of Serum Leptin in Critically Ill Patients with Acute versus Acute-on-Chronic Liver Failure" Biomedicines 12, no. 6: 1170. https://doi.org/10.3390/biomedicines12061170
APA StyleHohlstein, P., Salvarcioglu, C., Pollmanns, M. R., Adams, J. K., Abu Jhaisha, S., Kabak, E., Eisert, A., Hamesch, K., Weiskirchen, R., Koch, A., & Wirtz, T. H. (2024). Diagnostic and Prognostic Value of Serum Leptin in Critically Ill Patients with Acute versus Acute-on-Chronic Liver Failure. Biomedicines, 12(6), 1170. https://doi.org/10.3390/biomedicines12061170