Obesity and pro-inflammatory mediators are associated with acute kidney injury in patients with A/H1N1 influenza and acute respiratory distress syndrome

•Obesity related mediators are associated with poor outcomes in A/H1N1 infection.•Obesity and C-peptide are biomarkers of kidney injury in A/H1N1-ARDS patients.•Immuno-metabolic alterations contribute to severe A/H1N1 disease pathogenesis.

BackgroundThe obesity has been shown to increase the severity of A/H1N1 infection and the development of acute respiratory distress syndrome (ARDS) and organ involvement.MethodsCirculating levels of C-peptide, insulin, glucagon, leptin, acute phase reactants (procalcitonin, C-reactive protein, tissue plasminogen activator, and serum amyloids A and P), were measured in samples from 32 critically ill patients with A/H1N1 virus infection, 17 of whom had ARDS complicated by acute kidney injury (AKI) and 15 of whom had ARDS but did not develop AKI.ResultsPatients with ARDS and AKI (ARDS/AKI) had higher BMI and higher levels of C-peptide, insulin, leptin, procalcitonin and serum amyloid A compared to those ARDS patient who did not develop AKI. Adjusting for confounding variables using logistic regression analysis, higher levels of C-peptide (> 0.75 ng/mL) (OR = 64.8, 95% CI = 2.1-1980, p = 0.0006) and BMI > 30Kg/m2 (OR = 42.0, 95% CI = 1.2-1478, p = 0.04) were significantly associated with the development of AKI in ARDS patients.ConclusionHigh levels of C-peptide and BMI > 30 kg/m2 were associated with the development of AKI in ARDS patients due to A/H1N1 infection. These metabolic/obesity indicators, together with the profiles of pro-inflammatory acute phase proteins, may be important links between obesity and poor outcomes in A/H1N1 09 infection.