Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, London, UK.
Liver Int. 2012 Jan;32(1):128-36. doi: 10.1111/j.1478-3231.2011.02657.x. Epub 2011 Oct 12.
High density lipoprotein (HDL) plays an important role in the transport of cholesterol to the adrenal gland for steroidogenesis and may have actions that modulate response to infection and critical illness. The clinical relevance of HDL level in patients with liver failure remains poorly characterised.
In 164 critically-ill patients with acute (ALF) and acute on chronic liver failure (AOCLF) we evaluated the relationship between HDL levels measured on admission to intensive care unit (ICU) and survival, predisposition to sepsis and adrenocortical function assessed through the cortisol response to short synacthen testing (SST).
In acute liver failure and acute on chronic liver failure, high density lipoprotein levels were significantly lower in non-survivors (P < 0.01). Levels correlated closely with biochemical markers of liver function and the duration of liver failure. However, predictive accuracy was not superior to conventional markers and on multi-variate analysis did not show independent association with survival. Low HDL concentration was not associated with an increased incidence of sepsis either precipitating or complicating ICU admission. Evidence of adrenocortical insufficiency was present in more than half of patients undergoing SST and HDL level but not other lipid parameters correlated closely with cortisol increment after SST (r = 0.364, P < 0.0001).
High density lipoprotein levels are low in patients with liver failure and reflect its severity. Levels are lower in non-survivors but do not offer an advantage as early indicators of prognosis over conventional markers. No evidence of a major predisposing role for infection was found, but findings suggest a close link to adrenal function.
高密度脂蛋白（HDL）在胆固醇向肾上腺运输以进行类固醇生成中起着重要作用，并且可能具有调节感染和危重病反应的作用。肝功能衰竭患者的 HDL 水平的临床相关性尚未得到充分描述。
我们在 164 例患有急性（ALF）和慢性肝衰竭急性加重（AOCLF）的重症患者中，评估了入院时 ICU 中测量的 HDL 水平与存活率、易患败血症的倾向以及通过短 Synacthen 测试（SST）评估的肾上腺皮质功能之间的关系。
在急性肝衰竭和急性慢性肝衰竭中，非幸存者的高密度脂蛋白水平显着降低（P <0.01）。水平与肝功能的生化标志物密切相关，并且与肝功能衰竭的持续时间相关。但是，预测准确性并不优于常规标志物，并且在多变量分析中与存活率没有独立关联。低 HDL 浓度与 ICU 入院时的败血症发生率增加无关，无论是诱发还是并发。进行 SST 的患者中超过一半存在肾上腺皮质功能不全的证据，并且 HDL 水平而不是其他脂质参数与 SST 后皮质醇增加密切相关（r = 0.364，P <0.0001）。
肝功能衰竭患者的高密度脂蛋白水平较低，反映了其严重程度。非幸存者的水平较低，但作为预后的早期指标，与常规标志物相比并没有提供优势。没有发现感染的主要易患作用的证据，但研究结果表明与肾上腺功能密切相关。
