Leptin and leptin receptor polymorphisms are associated with poor outcome death in patients with non-appendicular secondary peritonitisReportar como inadecuado




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Critical Care

, 15:R227

First Online: 23 September 2011Received: 22 April 2011Revised: 31 August 2011Accepted: 23 September 2011

Abstract

IntroductionLeptin LEP and its receptor LEPR participate in the immunological response during infection. LEP serum levels rise during sepsis. In patients with peritonitis, an insufficient elevation in serum LEP is associated with an increased risk of death. As gene variants of LEP and LEPR have been associated with diverse pathologic conditions, we explored the association of genetic polymorphisms of LEP or LEPR with death in patients with secondary peritonitis.

MethodsA case control study was undertaken. LEP Gene -2548G > A and the LEPR Gene 223A > G polymorphism were determined in 74 patients. The odds ratio of genotype and allele distribution in survival control versus death case among patients was calculated. Serum LEP, interleukin IL-6, tumour necrosis factor alpha, C-reactive protein C-RP, IL-10 and IL-13 levels were analyzed in 34 patients.

ResultsThere were significant differences in genotype and allele distribution between survivors and non-survivors for -2548G > A and 223A > G polymorphisms. The presence of the mutant allele A, in -2548, had an odds ratio of 4.64 95% CI 1.22, 17.67 with significance P = 0.017 in the risk of death. The presence of mutant allele G, in 223, had an odds ratio of 3.57 95% CI 1.06, 12.01 with significance in the risk of death P = 0.033. The presence of allele A in the -2548 polymorphism was associated with differences in serum LEP P = 0.013, and IL-10 P = 0.0001. The presence of allele G in 223 polymorphism was likewise correlated with differences in serum LEP P < 0001, C-RP P = 0.033, and IL-10 P = 0.043.

ConclusionsThe polymorphisms studied are associated with death in patients with peritonitis of non-appendicular origin. This association is stronger than many known risk-factors related to peritonitis severity, and is independent of body mass. The physiopathologic mechanism is possibly related to an insufficient increase in the elevation of serum LEP levels, and is unrelated to body mass.

AbbreviationsBMIBody Mass Index

C-RPC-reactive protein

ILinterleukin

LEPleptin

LEPRleptin receptor

LPSlipopolysaccharide

MOFmultiple organ failure

MPIMannheim Peritonitis Index

OROdds ratios

PCRpolymorphism chain reaction

RFLPsrestriction fragment length polymorphism

SSDSecretaría de Salud de Durango

TNF-αtumour necrosis factor alpha

Electronic supplementary materialThe online version of this article doi:10.1186-cc10467 contains supplementary material, which is available to authorized users.

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Autor: Rodolfo L Bracho-Riquelme - Verónica Loera-Castañeda - Alejandro Torres-Valenzuela - Guadalupe A Loera-Castañeda - J Pab

Fuente: https://link.springer.com/







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