U-Shape Relationship between Plasma Leucine Level and Mortality in the Intensive Care Unit

Abstract

Patients in the intensive care unit (ICU) are at high risk of mortality which is not well predicted. Previous studies noted that leucine has prognostic value in a variety of diseases. This study investigated whether leucine concentration was a useful biomarker of metabolic and nutritional status and 6-month mortality in ICU. We recruited 454 subjects admitted to ICU (348 and 106 in the initiation and validation cohorts, respectively) with an acute physiology and chronic health evaluation (APACHE II) $\text{score}\ge 15$ . We measured plasma leucine concentrations, traditional biomarkers, and calculated APACHE II and sequential organ failure assessment (SOFA) scores. Leucine levels were weakly correlated with albumin, prealbumin, and transferrin levels ( $r=0.30$ , 0.12, and 0.15, $p=0.001$ , 0.029, and 0.007, respectively). During follow-up, 116 (33.3%) patients died. Compared to patients with leucine levels between 109 and 174 μM, patients with $\text{leucine}>174\mu \text{M}$ or <109 μM had a lower cumulative survival rate. Death was also associated with age, higher APACHE II and SOFA scores, C-reactive protein, and longer stays in the ICU, but with lower albumin, prealbumin, and transferrin. Patients with leucine $\text{levels}>174\mu \text{M}$ had higher alanine aminotransferase levels, but no significant differences in other variables; patients with leucine $\text{levels}<109\mu \text{M}$ had higher APACHE II and SOFA scores, higher incidence of using inotropic agents, longer ICU and hospital stays, but lower albumin and transferrin levels. Multivariable analysis demonstrated that $\text{leucine}>174\mu \text{M}$ was an independent predictor of mortality, especially early mortality. However, among patients who stayed in ICU longer than two weeks, $\text{leucine}<109\mu \text{M}$ was an independent predictor of mortality. In addition, $\text{leucine}<109\mu \text{M}$ was associated with worse ventilator weaning profiles. These findings were similar in the validation cohort. Our study demonstrated a U-shape relationship between leucine levels and mortality rate in ICU.