Signals from fat after injury

Plasma adipokines and ghrelin concentrations in the severely burned

Charles E. Wade, Alejandra G. Mora, Beth A. Shields, Heather F. Pidcoke, Lisa A. Baer, Kevin K. Chung, Steven Wolf

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction: Hypermetabolism is universal in the severely burned and is characterized by catabolism of lean mass and body fat with associated insulin resistance. Adipokines are likely to play a role in these changes but have not been identified to date in burn patients. Methods: From a single burn ICU, 17 burn patients with an expected stay >14. days were studied. Study period began within 14. days of admission. Over 7. days, plasma samples were collected for measurement of leptin, adiponectin, resistin, ghrelin, insulin, and cortisol by ELISA. For comparison, samples from 15 healthy controls of similar age, BMI, and blood glucose were obtained. Results: Mean age was 33. ±. 17. years and BMI 26. ±. 3.4. Average burn size was 45. ±. 20% TBSA and ISS 32. ±. 10 with 72% having inhalation injury; in-hospital mortality was 29%. Estimated energy needs were 3626. ±. 710. kcal, of which 84. ±. 21% were met by enteral feeding with intensive insulin treatment (glucose 80-110. mg/ml). Using the homeostasis model assessment of insulin resistance, burned subjects were more resistant than controls (17. ±. 11.3 and 8. ±. 10.0). Insulin levels were elevated (57. ±. 35.6. μU/ml in burned subject vs. 26. ±. 31.1. μU/ml in controls), and cortisol concentrations increased (50. ±. 41.2. μg/dl vs. 12. ±. 3.9. μg/dl). These traditional hormone changes were associated with increased resistin (16.6. ±. 5.5. ng/ml vs. 3.8. ±. 0.9. ng/ml) and decreased leptin (8.8. ±. 8.9. ng/ml vs. 19.4. ±. 23.5. ng/ml), adiponectin (9. ±. 3.5. ng/ml vs. 17. ±. 10.2. ng/ml), and ghrelin (0.37. ±. 0.14. ng/ml vs.0.56. ±. 0.26. ng/ml). Conclusion: Patients with burns, who are characteristically hypermetabolic with hypercortisolism and insulin resistant, have significant changes in adipokine levels that appear independent of the magnitude of initial injury or metabolic derangement. In addition, suppression of ghrelin in the presence of decreased leptin and adiponectin levels in combination with increased insulin and resistin levels represent unexpected changes in the metabolic milieu of the injured patient possibly due to dramatic activation of inflammatory pathways, indicating strategies for treatment.

Original languageEnglish (US)
Pages (from-to)78-83
Number of pages6
JournalCytokine
Volume61
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

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Ghrelin
Adipokines
Resistin
Fats
Insulin
Adiponectin
Plasmas
Leptin
Wounds and Injuries
Insulin Resistance
Hydrocortisone
Cushing Syndrome
Enteral Nutrition
Hospital Mortality
Burns
Inhalation
Intensive care units
Blood Glucose
Adipose Tissue
Homeostasis

Keywords

  • Adiponectin
  • Inflammation
  • Leptin
  • Metabolism
  • Resistin

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Biochemistry
  • Hematology
  • Molecular Biology

Cite this

Wade, C. E., Mora, A. G., Shields, B. A., Pidcoke, H. F., Baer, L. A., Chung, K. K., & Wolf, S. (2013). Signals from fat after injury: Plasma adipokines and ghrelin concentrations in the severely burned. Cytokine, 61(1), 78-83. https://doi.org/10.1016/j.cyto.2012.08.031

Signals from fat after injury : Plasma adipokines and ghrelin concentrations in the severely burned. / Wade, Charles E.; Mora, Alejandra G.; Shields, Beth A.; Pidcoke, Heather F.; Baer, Lisa A.; Chung, Kevin K.; Wolf, Steven.

In: Cytokine, Vol. 61, No. 1, 01.01.2013, p. 78-83.

Research output: Contribution to journalArticle

Wade, Charles E. ; Mora, Alejandra G. ; Shields, Beth A. ; Pidcoke, Heather F. ; Baer, Lisa A. ; Chung, Kevin K. ; Wolf, Steven. / Signals from fat after injury : Plasma adipokines and ghrelin concentrations in the severely burned. In: Cytokine. 2013 ; Vol. 61, No. 1. pp. 78-83.
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abstract = "Introduction: Hypermetabolism is universal in the severely burned and is characterized by catabolism of lean mass and body fat with associated insulin resistance. Adipokines are likely to play a role in these changes but have not been identified to date in burn patients. Methods: From a single burn ICU, 17 burn patients with an expected stay >14. days were studied. Study period began within 14. days of admission. Over 7. days, plasma samples were collected for measurement of leptin, adiponectin, resistin, ghrelin, insulin, and cortisol by ELISA. For comparison, samples from 15 healthy controls of similar age, BMI, and blood glucose were obtained. Results: Mean age was 33. ±. 17. years and BMI 26. ±. 3.4. Average burn size was 45. ±. 20{\%} TBSA and ISS 32. ±. 10 with 72{\%} having inhalation injury; in-hospital mortality was 29{\%}. Estimated energy needs were 3626. ±. 710. kcal, of which 84. ±. 21{\%} were met by enteral feeding with intensive insulin treatment (glucose 80-110. mg/ml). Using the homeostasis model assessment of insulin resistance, burned subjects were more resistant than controls (17. ±. 11.3 and 8. ±. 10.0). Insulin levels were elevated (57. ±. 35.6. μU/ml in burned subject vs. 26. ±. 31.1. μU/ml in controls), and cortisol concentrations increased (50. ±. 41.2. μg/dl vs. 12. ±. 3.9. μg/dl). These traditional hormone changes were associated with increased resistin (16.6. ±. 5.5. ng/ml vs. 3.8. ±. 0.9. ng/ml) and decreased leptin (8.8. ±. 8.9. ng/ml vs. 19.4. ±. 23.5. ng/ml), adiponectin (9. ±. 3.5. ng/ml vs. 17. ±. 10.2. ng/ml), and ghrelin (0.37. ±. 0.14. ng/ml vs.0.56. ±. 0.26. ng/ml). Conclusion: Patients with burns, who are characteristically hypermetabolic with hypercortisolism and insulin resistant, have significant changes in adipokine levels that appear independent of the magnitude of initial injury or metabolic derangement. In addition, suppression of ghrelin in the presence of decreased leptin and adiponectin levels in combination with increased insulin and resistin levels represent unexpected changes in the metabolic milieu of the injured patient possibly due to dramatic activation of inflammatory pathways, indicating strategies for treatment.",
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N2 - Introduction: Hypermetabolism is universal in the severely burned and is characterized by catabolism of lean mass and body fat with associated insulin resistance. Adipokines are likely to play a role in these changes but have not been identified to date in burn patients. Methods: From a single burn ICU, 17 burn patients with an expected stay >14. days were studied. Study period began within 14. days of admission. Over 7. days, plasma samples were collected for measurement of leptin, adiponectin, resistin, ghrelin, insulin, and cortisol by ELISA. For comparison, samples from 15 healthy controls of similar age, BMI, and blood glucose were obtained. Results: Mean age was 33. ±. 17. years and BMI 26. ±. 3.4. Average burn size was 45. ±. 20% TBSA and ISS 32. ±. 10 with 72% having inhalation injury; in-hospital mortality was 29%. Estimated energy needs were 3626. ±. 710. kcal, of which 84. ±. 21% were met by enteral feeding with intensive insulin treatment (glucose 80-110. mg/ml). Using the homeostasis model assessment of insulin resistance, burned subjects were more resistant than controls (17. ±. 11.3 and 8. ±. 10.0). Insulin levels were elevated (57. ±. 35.6. μU/ml in burned subject vs. 26. ±. 31.1. μU/ml in controls), and cortisol concentrations increased (50. ±. 41.2. μg/dl vs. 12. ±. 3.9. μg/dl). These traditional hormone changes were associated with increased resistin (16.6. ±. 5.5. ng/ml vs. 3.8. ±. 0.9. ng/ml) and decreased leptin (8.8. ±. 8.9. ng/ml vs. 19.4. ±. 23.5. ng/ml), adiponectin (9. ±. 3.5. ng/ml vs. 17. ±. 10.2. ng/ml), and ghrelin (0.37. ±. 0.14. ng/ml vs.0.56. ±. 0.26. ng/ml). Conclusion: Patients with burns, who are characteristically hypermetabolic with hypercortisolism and insulin resistant, have significant changes in adipokine levels that appear independent of the magnitude of initial injury or metabolic derangement. In addition, suppression of ghrelin in the presence of decreased leptin and adiponectin levels in combination with increased insulin and resistin levels represent unexpected changes in the metabolic milieu of the injured patient possibly due to dramatic activation of inflammatory pathways, indicating strategies for treatment.

AB - Introduction: Hypermetabolism is universal in the severely burned and is characterized by catabolism of lean mass and body fat with associated insulin resistance. Adipokines are likely to play a role in these changes but have not been identified to date in burn patients. Methods: From a single burn ICU, 17 burn patients with an expected stay >14. days were studied. Study period began within 14. days of admission. Over 7. days, plasma samples were collected for measurement of leptin, adiponectin, resistin, ghrelin, insulin, and cortisol by ELISA. For comparison, samples from 15 healthy controls of similar age, BMI, and blood glucose were obtained. Results: Mean age was 33. ±. 17. years and BMI 26. ±. 3.4. Average burn size was 45. ±. 20% TBSA and ISS 32. ±. 10 with 72% having inhalation injury; in-hospital mortality was 29%. Estimated energy needs were 3626. ±. 710. kcal, of which 84. ±. 21% were met by enteral feeding with intensive insulin treatment (glucose 80-110. mg/ml). Using the homeostasis model assessment of insulin resistance, burned subjects were more resistant than controls (17. ±. 11.3 and 8. ±. 10.0). Insulin levels were elevated (57. ±. 35.6. μU/ml in burned subject vs. 26. ±. 31.1. μU/ml in controls), and cortisol concentrations increased (50. ±. 41.2. μg/dl vs. 12. ±. 3.9. μg/dl). These traditional hormone changes were associated with increased resistin (16.6. ±. 5.5. ng/ml vs. 3.8. ±. 0.9. ng/ml) and decreased leptin (8.8. ±. 8.9. ng/ml vs. 19.4. ±. 23.5. ng/ml), adiponectin (9. ±. 3.5. ng/ml vs. 17. ±. 10.2. ng/ml), and ghrelin (0.37. ±. 0.14. ng/ml vs.0.56. ±. 0.26. ng/ml). Conclusion: Patients with burns, who are characteristically hypermetabolic with hypercortisolism and insulin resistant, have significant changes in adipokine levels that appear independent of the magnitude of initial injury or metabolic derangement. In addition, suppression of ghrelin in the presence of decreased leptin and adiponectin levels in combination with increased insulin and resistin levels represent unexpected changes in the metabolic milieu of the injured patient possibly due to dramatic activation of inflammatory pathways, indicating strategies for treatment.

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