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Leptin (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.    Methods  A 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.    Results  There 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).    Conclusions  The 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.

Leptin and leptin receptor polymorphisms are associated with poor outcome (death) in patients with non-appendicular secondary peritonitis