While survival differences between high and low PERP cohorts did not reach statistical significance (663 versus 588 days, P = 0.4050; hazard ratio [HR] = 1.13, 95% CI, 0.85–1.52), studies with larger patient cohorts are warranted, given observed data trends after adjusting for age, sex, obesity, and patient-reported DM (Supplemental Figure 7, A and B, and Supplemental Table 3). Here, PERP is linked to obesity due to melanocortin 4 receptor deficiency.