Tanaka Sébastien, Labreuche Julien, Drumez Elodie, Harrois Anatole, Hamada Sophie, Vigué Bernard, Couret David, Duranteau Jacques, Meilhac Olivier
Assistance Publique des Hopitaux de Paris, Service d'Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, le Kremlin-Bicêtre, France.
Département de biostatistique, Université de Lille, CHU Lille, EA 2694 - Santé publique, épidémiologie et qualité des soins, 59000, Lille, France.
Ann Intensive Care. 2017 Dec;7(1):60. doi: 10.1186/s13613-017-0284-3. Epub 2017 Jun 6.
The protective cardiovascular effect of high-density lipoproteins (HDLs) is considered to chiefly rely on reverse cholesterol transport from peripheral tissues back to the liver. However, HDL particles display pleiotropic properties, including anti-inflammatory, anti-apoptotic or antioxidant functions. Some studies suggest that HDL concentration decreases during sepsis, and an association was reported between low HDL levels and a poor outcome. Like sepsis, trauma is also associated with a systemic inflammatory response syndrome. However, no study has yet explored changes in lipid profiles during trauma. We sought to compare lipid profiles between sepsis and trauma patients in intensive care unit (ICU). In septic patients, we analyzed the association between lipid profile, severity and prognosis.
A prospective, observational, single-centered study was conducted in a surgical ICU. For each patient, total cholesterol, HDL, triglyceride and low-density lipoprotein cholesterol levels were assessed at admission. Short-term prognosis outcome was prospectively assessed.
Seventy-five consecutive patients were admitted (50 sepsis and 25 trauma). There was no difference in SOFA and SAPSII scores between the two groups. Patients with sepsis had lower total cholesterol levels than patients with trauma. Regarding the lipoprotein profile, only HDLs differed significantly between the two groups (median [IQR] = 0.33 mmol/l [0.17-0.78] in sepsis patients versus median [IQR] = 0.99 mmol/l [0.74-1.28] in trauma patients; P < 0.0001). Whereas ICU mortality was not associated with lipid levels in the sepsis group, a significant negative correlation was found between HDL concentration and the length of ICU stay (r = -0.35; P = 0.03) in the group of survivor septic patients at ICU discharge. In addition, poor outcome defined as death or a SOFA score >6 at day 3 was associated with lower HDL levels (median [IQR] = 0.20 mmol/l [0.11-0.41] vs. 0.35 mmol/l [0.19-0.86] in patients with poor outcome versus others; P = 0.03).
Lipid profile was totally different between sepsis and trauma in ICU patients: HDL levels were low in septic patients, whereas their concentration was not altered in trauma patients. This major difference reinforces the necessity to explore the therapeutic potential of HDL in sepsis.
高密度脂蛋白（HDL）对心血管的保护作用主要被认为依赖于胆固醇从外周组织逆向转运回肝脏。然而，HDL颗粒具有多种特性，包括抗炎、抗凋亡或抗氧化功能。一些研究表明，脓毒症期间HDL浓度会降低，并且低HDL水平与不良预后之间存在关联。与脓毒症一样，创伤也与全身炎症反应综合征相关。然而，尚无研究探讨创伤期间血脂谱的变化。我们试图比较重症监护病房（ICU）中脓毒症患者和创伤患者的血脂谱。在脓毒症患者中，我们分析了血脂谱、严重程度与预后之间的关联。
在一家外科ICU进行了一项前瞻性、观察性、单中心研究。对每位患者在入院时评估总胆固醇、HDL、甘油三酯和低密度脂蛋白胆固醇水平。前瞻性评估短期预后结果。
连续收治75例患者（50例脓毒症患者和25例创伤患者）。两组间序贯器官衰竭评估（SOFA）和简化急性生理学评分（SAPSII）无差异。脓毒症患者的总胆固醇水平低于创伤患者。关于脂蛋白谱，两组间仅HDL有显著差异（脓毒症患者中位数[四分位间距] = 0.33 mmol/L[0.17 - 0.78]，创伤患者中位数[四分位间距] = 0.99 mmol/L[0.74 - 1.28]；P < 0.0001）。在脓毒症组中，ICU死亡率与血脂水平无关，但在ICU出院时存活的脓毒症患者组中，HDL浓度与ICU住院时间之间存在显著负相关（r = -0.35；P = 0.03）。此外，以第3天死亡或SOFA评分>6定义的不良预后与较低的HDL水平相关（不良预后患者中位数[四分位间距] = 0.20 mmol/L[0.11 - 0.41]，其他患者为0.35 mmol/L[0.19 - 0.86]；P = 0.03）。
ICU患者中脓毒症和创伤的血脂谱完全不同：脓毒症患者HDL水平低，而创伤患者其浓度未改变。这一主要差异强化了探索HDL在脓毒症中治疗潜力的必要性。
