Postoperative Dynamic of Leptin and Fibroblast Growth Factor 21 in 123 Patients Recovering from Cardiac Surgery

BACKGROUND: Cardiac surgery triggers acute changes in serum leptin and fibroblast growth factor 21 (FGF-21). Considering their pleiotropic role in inflammation and abnormal glucose metabolism, perseverance of their abnormal serum level can have a long-term impact on recovery and end-organ failures. Long-term dynamics after cardiac surgery are unknown. MATERIAL/METHODS: Serum was collected from 123 patients before cardiac surgery (t(baseline)) and 24 h (t(24h)), 7 days (t(7d)), and 3 months (t(3m)) later. Also, interleukin 6 (IL-6) and C-reactive protein (CRP) assessed nonspecific inflammatory responses. Neurodegeneration was gauged with serum amyloid β1–40 and β1–42. Demographic and clinical information, including disposition at 28 days and t(3m) from admission, were collected. RESULTS: Serum leptin increased at t(24h) (leptin(baseline)=613±747.9 vs leptin(24h)=768±718.1; P=0.0083) and decreased at t(7d) (leptin(7d)=499.5±540.2; P=0.043). FGF-21 levels increased at t(24h) and t(7d). Cytokines normalized by t(3m). Presurgical leptin levels were higher in Asians and were the primary determinant of postoperative leptin changes. Leptin levels were most elevated in patients undergoing aortic valve and arch surgery; the perioperative increase was significant only in patients with mitral valve surgery. Leptin and FGF-21 did not correlate with markers of general inflammation (CRP, IL-6), which partially resolved after t(3m). Amyloid β1–42 at t(3m) correlated with leptin peak at t(24h). Low prehospital FGF-21 level correlated with the incidence of perioperative stroke; postoperative FGF-21 correlated with discharge to facility vs home. CONCLUSIONS: : Leptin and FGF-21 evolve independently from the inflammatory response in the aftermath of cardiac surgery and correlate with cardiac remodeling and neurodegeneration markers.