Signals from fat after injury: Plasma adipokines and ghrelin concentrations in the severely burned

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 seven 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.

Severe burn and disuse in the rat independently adversely impact body composition and adipokines

“…Both leptin and adiponectin have recently been shown to be reduced in critically ill patients and associated with stress related parameters [15,49,50]. We have recently seen similar changes in adipokines in patients with severe burns [16]. These adipokines have been suggested to play important roles in tissue inflammation; however, a role in critically ill patients has yet to be elucidated [51-53].…”

The Potential of Adipokines in Identifying Multiple Trauma Patients at Risk of Developing Multiple Organ Dysfunction Syndrome

“…In our study, there were statistically signi cant positive correlations between the resistin concentrations of the multiple trauma patients and the corresponding SIRS and MOF scores. Wade et al found a signi cant positive correlation between the resistin plasma concentrations and the multiple organ dysfunction score in patients with burn trauma [44]. In addition, Sundén-Cullberg et al demonstrated a statistically signi cant correlation between the resistin concentrations and the SOFA score in sepsis patients [45].…”

Cutting-Edge Forward Burn Nutrition: from the Battlefield to the Burn Center

“…When the patient has no difficulty tolerating oral feeding, soft, bland foods are recommended for the first meal and chewing foods thoroughly is encouraged. Patients are often easily satiated and therefore have minimal solid food intake, but they are extremely thirsty, which aids in meeting calorie goals by drinking 8-24 supplement drinks per day [42]. Water, Gatorade®, Kool-Aid®, fruit juices, and sodas are not calorically dense enough to adequately support nutrition in the hypermetabolic state.…”