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Cardiopulmonary bypass surgery does not further increase elevated serum leptin concentrations after major surgery
Jörg Dötsch1, Roland Wagner, Michael Gröschl
1Departments of Pediatrics (Dr. Dötsch, Mr. Wagner, Mr. Gröschl, Drs. Schoof, Scharf, Dörr, and Rascher), Cardiac Surgery (Dr. Harig), and Pediatric Cardiology (Dr. Singer), University of Erlangen-Nürnberg, Loschgestr., Erlangen, Germany, the Department of Clinical Chemistry and Pathobiochemistry (Dr. Katz), Justus-Liebig-University of Giessen, and Lilly Deutschland GmbH (Dr. Blum), Bad Homburg, Germany.
Insights
Major heart surgery in children impacts serum leptin levels, showing similar increases after cardiopulmonary bypass (CPB) and non-CPB surgery, suggesting inflammation doesn't further elevate leptin post-surgery.
Area of Science:
- Pediatric Endocrinology
- Cardiovascular Surgery
- Metabolic Regulation
Background:
- Leptin, a key metabolic hormone, plays a role in energy balance and inflammation.
- Major surgery, particularly with cardiopulmonary bypass (CPB), induces significant physiological stress.
- The interplay between surgical stress, inflammation, and leptin regulation in pediatric patients remains incompletely understood.
Purpose of the Study:
- To investigate the effect of major heart surgery with cardiopulmonary bypass (CPB) on serum leptin concentrations in children.
- To analyze the relationship between serum leptin and plasma cortisol, epinephrine, norepinephrine, and insulin levels post-surgery.
- To determine if CPB surgery influences leptin levels differently compared to major non-CPB surgery.
Main Methods:
- A controlled, prospective study involving 20 pediatric patients undergoing open heart surgery with CPB and 20 controls undergoing major non-CPB surgery.
- Serum leptin measured by radioimmunoassay.
- Plasma cortisol, insulin, epinephrine, and norepinephrine measured by chemiluminescence and high-pressure liquid chromatography.
Main Results:
- Serum leptin decreased intraoperatively in the CPB group but significantly increased 12 hours post-surgery in both CPB and non-CPB groups.
- Plasma cortisol, insulin, and epinephrine levels significantly increased in both surgical groups post-operatively.
- No correlation was found between the peak increase in serum leptin and the levels of other measured hormones.
Conclusions:
- Pediatric patients undergoing CPB and non-CPB major surgery exhibit similar post-operative increases in serum leptin.
- The sepsis-like inflammatory syndrome associated with major surgery does not appear to further elevate leptin concentrations.
- Serum leptin regulation in the context of major pediatric surgery is complex and not solely dependent on known regulatory factors.
Abstract:
OBJECTIVE: The objective of the present study was to examine the impact of major heart surgery with cardiopulmonary bypass (CPB) in childhood on serum leptin concentrations in relation to plasma cortisol, epinephrine, norepinephrine, and insulin. DESIGN: Controlled, prospective study. SETTING: Intensive care unit of a university hospital. Patients and INTERVENTIONS: We enrolled 20 pediatric patients undergoing open heart surgery and 20 children with major surgery not necessitating CPB (surgical control group). Leptin was measured by radioimmunoassay, cortisol and insulin were measured by chemiluminescence, and epinephrine and norepinephrine were measured by high-pressure liquid chromatography. MEASUREMENTS AND MAIN RESULTS: In the CPB group, leptin dropped from 0.4 +/- 0.1 preoperatively (mean +/- sem) to 0.2 +/- 0.1 ng/mL intraoperatively (p <.05). It increased to 1.6 +/- 0.7 ng/mL 12 hrs after surgery (p <.01) and declined thereafter. In the surgical controls, leptin rose from 0.5 +/- 0.2 ng/mL before surgery to 1.8 +/- 0.8 ng/mL 12 hrs after surgery (p =.001). In both groups, plasma cortisol, insulin, and epinephrine significantly increased after surgery. There was no relationship between the maximum increase of serum leptin and the other hormones. CONCLUSIONS: Patients with CPB surgery and non-CPB surgery show a similar increase in serum leptin, indicating that sepsislike inflammatory syndrome does not further increase elevated leptin concentrations following major surgery. In this complex situation, serum leptin does not appear to be merely regulated by its known stimuli and suppressors.