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The relationship between lipid levels and clinical outcomes in sepsis patients in the intensive care unit: a retrospective study

Yıl 2024, Cilt: 7 Sayı: 6, 615 - 620, 27.10.2024

Öz

Aims: This study aimed to investigate the relationship between serum cholesterol levels (HDL-C, LDL-C, and triglycerides) and clinical outcomes in sepsis patients in an intensive care unit (ICU).
Methods: This retrospective study included patients aged >18 years diagnosed with sepsis who were admitted to the Internal Medicine ICUs of Konya City Hospital between June 15, 2021, and March 6, 2024. All data were obtained from routine blood tests of the patients in the ICU.
Results: The study included 477 patients (median age, 73 years; females, 45.9%). The median levels of APACHE-II and SOFA scores were 27 (range, 5-55) and 7 (range, 2-19) points, respectively. The survived patients were younger and had lower median APACHE and SOFA scores compared to the non-survived patients (p<0.05 for all). The survived patients had higher levels of platelets, albumin, and HbA1c (p=0.001, p<0.001, and p=0.022, respectively), but significantly lower levels of HDL-C, triglycerides, and C-reactive protein (CRP) compared to the non-survived patients (p=0.026, p=0.011, p=0.034, respectively). In multivariable regression analyses to document independently related parameters, it was found that age (HR: 1.030), SOFA score (HR: 1.891), HDL-C (HR: 1.054), and triglyceride (HR: 1.007) levels were positively and independently related, while acute pancreatitis (HR: 0.057) and albumin levels (HR: 0.428) were inversely related to in-hospital mortality in the study population (all had p-value <0.05).
Conclusion: The findings highlight the potential utility of lipid biomarkers in risk assessment and prognostication in critically ill patients, emphasizing the need for further prospective research to elucidate underlying mechanisms and optimize therapeutic strategies for sepsis management in intensive care settings.

Kaynakça

  • Kim JY, Lee EY, Park JK, Song YW, Kim JR, Cho KH. Patients with rheumatoid arthritis show altered lipoprotein profiles with dysfunctional high-density lipoproteins that can exacerbate inflammatory and atherogenic process. PLoS One. 2016;11(10): e0164564.
  • Robertson KA, Ghazal P. Interferon control of the sterol metabolic network: bidirectional molecular circuitry-mediating host protection. Front Immunol. 2016;7:634.
  • Yao Z, Mates JM, Cheplowitz AM, et al. Blood-borne lipopolysaccharide is rapidly eliminated by liver sinusoidal endothelial cells via high-density lipoprotein. J Immunol. 2016; 197(6):2390-2399.
  • Surbatovic M, Popovic N, Vojvodic D, et al. Cytokine profile in severe gram-positive and gram-negative abdominal sepsis. Sci Rep. 2015;5:11355.
  • Damas P, Ledoux D, Nys M, et al. Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg. 1992;215(4):356-362.
  • Lekkou A, Mouzaki A, Siagris D, Ravani I, Gogos CA. Serum lipid profile, cytokine production, and clinical outcome in patients with severe sepsis. J Crit Care. 2014;29(5):723-727.
  • Fraunberger P, Pilz G, Cremer P, Werdan K, Walli AK. Association of serum tumor necrosis factor levels with decrease of cholesterol during septic shock. Shock. 1998;10(5):359-363.
  • Barlage S, Gnewuch C, Liebisch G, et al. Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation. Int Care Med. 2009;35(11):1877-1885.
  • Memiş D, Gursoy O, Tasdogan M, et al. High C-reactive protein and low cholesterol levels are prognostic markers of survival in severe sepsis. J Clin Anesth. 2007;19(3):186-191.
  • Liu SH, Liang HY, Li HY, Ding XF, Sun TW, Wang J. Effect of low high-density lipoprotein levels on mortality of septic patients: a systematic review and meta-analysis of cohort studies. World J Emerg Med. 2020;11(2):109-116.
  • Hofmaenner DA, Arina P, Kleyman A, et al. Association between hypocholesterolemia and mortality in critically ill patients with sepsis: a systematic review and meta-analysis. Crit Care Explor. 2023;5(2):e0860.
  • Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016; 315(8):762-774.
  • Taylor R, Zhang C, George D, et al. Low circulatory levels of total cholesterol, HDL-C and LDL-C are associated with death of patients with sepsis and critical illness: systematic review, meta-analysis, and perspective of observational studies. EBioMedicine. 2024;100:104981.
  • Chien JY, Jerng JS, Yu CJ, Yang PC. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Crit Care Med. 2005;33(8):1688-1693.
  • van Leeuwen HJ, Heezius EC, Dallinga GM, van Strijp JA, Verhoef J, van Kessel KP. Lipoprotein metabolism in patients with severe sepsis. Crit Care Med. 2003;31(5):1359-1366.
  • Maile MD, Sigakis MJ, Stringer KA, Jewell ES, Engoren MC. Impact of the pre-illness lipid profile on sepsis mortality. J Crit Care. 2020;57:197-202.
  • Aydemir S, & Hoşgün D. The role of serum lipoprotein levels in predicting independent short-term mortality in COVID-19 patients. Anat Curr Med J. 2022;4(2):162-166.
  • Guirgis FW, Dodani S, Leeuwenburgh C, et al. HDL inflammatory index correlates with and predicts severity of organ failure in patients with sepsis and septic shock. PLoS One. 2018;13(9):e0203813.
  • Tanaka S, Couret D, Tran-Dinh A, et al. High-density lipoproteins during sepsis: from bench to bedside. Crit Care. 2020;24(1):134.
  • Presterl E, Staudinger T, Pettermann M, et al. Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis. Am J Respir Crit Care Med. 1997;156(3 Pt 1):825-832.
  • Novak F, Borovska J, Vecka M, et al. Plasma phospholipid fatty acid profile is altered in both septic and non-septic critically ill: a correlation with inflammatory markers and albumin. Lipids. 2017;52(3):245-254.
  • Guo JY, Chou RH, Kuo CS, et al. The paradox of the glycemic gap: Does relative hypoglycemia exist in critically ill patients?. Clin Nutr. 2021;40(7):4654-4661.
  • Hofmaenner DA, Kleyman A, Press A, Bauer M, Singer M. The many roles of cholesterol in sepsis: a review. Am J Respir Crit Care Med. 2022;205(4):388-396.
Yıl 2024, Cilt: 7 Sayı: 6, 615 - 620, 27.10.2024

Öz

Kaynakça

  • Kim JY, Lee EY, Park JK, Song YW, Kim JR, Cho KH. Patients with rheumatoid arthritis show altered lipoprotein profiles with dysfunctional high-density lipoproteins that can exacerbate inflammatory and atherogenic process. PLoS One. 2016;11(10): e0164564.
  • Robertson KA, Ghazal P. Interferon control of the sterol metabolic network: bidirectional molecular circuitry-mediating host protection. Front Immunol. 2016;7:634.
  • Yao Z, Mates JM, Cheplowitz AM, et al. Blood-borne lipopolysaccharide is rapidly eliminated by liver sinusoidal endothelial cells via high-density lipoprotein. J Immunol. 2016; 197(6):2390-2399.
  • Surbatovic M, Popovic N, Vojvodic D, et al. Cytokine profile in severe gram-positive and gram-negative abdominal sepsis. Sci Rep. 2015;5:11355.
  • Damas P, Ledoux D, Nys M, et al. Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg. 1992;215(4):356-362.
  • Lekkou A, Mouzaki A, Siagris D, Ravani I, Gogos CA. Serum lipid profile, cytokine production, and clinical outcome in patients with severe sepsis. J Crit Care. 2014;29(5):723-727.
  • Fraunberger P, Pilz G, Cremer P, Werdan K, Walli AK. Association of serum tumor necrosis factor levels with decrease of cholesterol during septic shock. Shock. 1998;10(5):359-363.
  • Barlage S, Gnewuch C, Liebisch G, et al. Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation. Int Care Med. 2009;35(11):1877-1885.
  • Memiş D, Gursoy O, Tasdogan M, et al. High C-reactive protein and low cholesterol levels are prognostic markers of survival in severe sepsis. J Clin Anesth. 2007;19(3):186-191.
  • Liu SH, Liang HY, Li HY, Ding XF, Sun TW, Wang J. Effect of low high-density lipoprotein levels on mortality of septic patients: a systematic review and meta-analysis of cohort studies. World J Emerg Med. 2020;11(2):109-116.
  • Hofmaenner DA, Arina P, Kleyman A, et al. Association between hypocholesterolemia and mortality in critically ill patients with sepsis: a systematic review and meta-analysis. Crit Care Explor. 2023;5(2):e0860.
  • Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). Jama. 2016; 315(8):762-774.
  • Taylor R, Zhang C, George D, et al. Low circulatory levels of total cholesterol, HDL-C and LDL-C are associated with death of patients with sepsis and critical illness: systematic review, meta-analysis, and perspective of observational studies. EBioMedicine. 2024;100:104981.
  • Chien JY, Jerng JS, Yu CJ, Yang PC. Low serum level of high-density lipoprotein cholesterol is a poor prognostic factor for severe sepsis. Crit Care Med. 2005;33(8):1688-1693.
  • van Leeuwen HJ, Heezius EC, Dallinga GM, van Strijp JA, Verhoef J, van Kessel KP. Lipoprotein metabolism in patients with severe sepsis. Crit Care Med. 2003;31(5):1359-1366.
  • Maile MD, Sigakis MJ, Stringer KA, Jewell ES, Engoren MC. Impact of the pre-illness lipid profile on sepsis mortality. J Crit Care. 2020;57:197-202.
  • Aydemir S, & Hoşgün D. The role of serum lipoprotein levels in predicting independent short-term mortality in COVID-19 patients. Anat Curr Med J. 2022;4(2):162-166.
  • Guirgis FW, Dodani S, Leeuwenburgh C, et al. HDL inflammatory index correlates with and predicts severity of organ failure in patients with sepsis and septic shock. PLoS One. 2018;13(9):e0203813.
  • Tanaka S, Couret D, Tran-Dinh A, et al. High-density lipoproteins during sepsis: from bench to bedside. Crit Care. 2020;24(1):134.
  • Presterl E, Staudinger T, Pettermann M, et al. Cytokine profile and correlation to the APACHE III and MPM II scores in patients with sepsis. Am J Respir Crit Care Med. 1997;156(3 Pt 1):825-832.
  • Novak F, Borovska J, Vecka M, et al. Plasma phospholipid fatty acid profile is altered in both septic and non-septic critically ill: a correlation with inflammatory markers and albumin. Lipids. 2017;52(3):245-254.
  • Guo JY, Chou RH, Kuo CS, et al. The paradox of the glycemic gap: Does relative hypoglycemia exist in critically ill patients?. Clin Nutr. 2021;40(7):4654-4661.
  • Hofmaenner DA, Kleyman A, Press A, Bauer M, Singer M. The many roles of cholesterol in sepsis: a review. Am J Respir Crit Care Med. 2022;205(4):388-396.
Toplam 23 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular İç Hastalıkları, Yoğun Bakım
Bölüm Orijinal Makale
Yazarlar

Korhan Kollu 0000-0002-0973-724X

Muhammet Cemal Kızılarslanoğlu 0000-0002-7632-6811

Yayımlanma Tarihi 27 Ekim 2024
Gönderilme Tarihi 1 Temmuz 2024
Kabul Tarihi 1 Ekim 2024
Yayımlandığı Sayı Yıl 2024 Cilt: 7 Sayı: 6

Kaynak Göster

AMA Kollu K, Kızılarslanoğlu MC. The relationship between lipid levels and clinical outcomes in sepsis patients in the intensive care unit: a retrospective study. J Health Sci Med /JHSM /jhsm. Ekim 2024;7(6):615-620.

Üniversitelerarası Kurul (ÜAK) Eşdeğerliği:  Ulakbim TR Dizin'de olan dergilerde yayımlanan makale [10 PUAN] ve 1a, b, c hariç  uluslararası indekslerde (1d) olan dergilerde yayımlanan makale [5 PUAN]

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Not:
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Yüksek Öğretim Kurumu (YÖK) kriterlerine göre yağmacı/şüpheli dergiler hakkındaki kararları ile yazar aydınlatma metni ve dergi ücretlendirme politikasını tarayıcınızdan indirebilirsiniz. https://dergipark.org.tr/tr/journal/2316/file/4905/show 


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