Department of Emergency Medicine, 137869University of Florida College of Medicine - Jacksonville, Jacksonville, FL, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
J Intensive Care Med. 2021 Jul;36(7):808-817. doi: 10.1177/0885066620931473. Epub 2020 Jun 24.
Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance.
This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative. We investigated quantitative (levels) and qualitative (dysfunctional high-density lipoprotein [HDL]) cholesterol differences. We used multivariable logistic regression to control for disease severity.
Among 171 patients with sepsis, infections were gram negative in 67, gram positive in 46, and culture negative in 47. Both gram-negative and gram-positive infections occurred in 11 patients. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels were lower for culture-positive sepsis at enrollment (TC, < .001; LDL-C, < .001; HDL-C, = .011) and persisted after controlling for disease severity. Similarly, cholesterol levels were lower among culture-positive patients at 48 hours (TC, = .012; LDL-C, = .029; HDL-C, = .002). Triglyceride (TG) levels were lower at enrollment ( =.033) but not at 48 hours ( = .212). There were no differences in dysfunctional HDL. Among bacteremic patients, cholesterol levels were lower at enrollment (TC, = .010; LDL-C, = .010; HDL-C, ≤ .001; TG, = .005) and at 48 hours (LDL-C, = .027; HDL-C, < .001; TG, = .020), except for 48 hour TC ( = .051). In the bacteremia subgroup, enrollment TC and LDL-C were lower for gram-negative versus gram-positive infections (TC, = .039; LDL-C, = .023).
Cholesterol levels are significantly lower among patients with culture-positive sepsis and bacteremia.
在脓毒症中，胆固醇水平降低与器官衰竭和死亡率增加有关。胆固醇水平可能因感染类型（革兰氏阴性与阳性）而异，这可能反映了胆固醇介导的细菌清除能力的差异。
这是对符合 Sepsis-3 标准的成人患者的两项前瞻性队列研究的合并数据进行的二次分析。感染类型分为革兰氏阴性、革兰氏阳性或培养阴性。我们研究了定量（水平）和定性（功能失调的高密度脂蛋白 [HDL]）胆固醇差异。我们使用多变量逻辑回归来控制疾病严重程度。
在 171 名脓毒症患者中，感染为革兰氏阴性的有 67 例，革兰氏阳性的有 46 例，培养阴性的有 47 例。革兰氏阴性和革兰氏阳性感染均发生在 11 例患者中。在入组时，培养阳性的脓毒症患者的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）水平较低（TC，<.001；LDL-C，<.001；HDL-C， =.011），且在控制疾病严重程度后仍持续存在。同样，在 48 小时时，培养阳性的患者胆固醇水平也较低（TC， =.012；LDL-C， =.029；HDL-C， =.002）。在入组时，甘油三酯（TG）水平较低（ =.033），但在 48 小时时则不然（ =.212）。在功能失调的 HDL 方面没有差异。在菌血症患者中，在入组时胆固醇水平较低（TC， =.010；LDL-C， =.010；HDL-C， ≤.001；TG， =.005），在 48 小时时也较低（LDL-C， =.027；HDL-C，<.001；TG， =.020），除了 48 小时 TC （ =.051）。在菌血症亚组中，与革兰氏阳性感染相比，革兰氏阴性感染的入组 TC 和 LDL-C 水平较低（TC， =.039；LDL-C， =.023）。
培养阳性脓毒症和菌血症患者的胆固醇水平明显较低。
