Nabavi Azam, Allami Abbas, QasemiBarqi Reza
Department of Infectious Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Med J Islam Repub Iran. 2020 May 9;34:45. doi: 10.34171/mjiri.34.45. eCollection 2020.
Lipid profiles are infrequently measured in clinical management of sepsis patients. Sepsis leads to significant alterations in the metabolism of lipids. The aim of the present study was to determine whether changes in plasma lipid concentrations during sepsis treatment were associated with clinical outcome. In this study, 74 adult septic patients were included in this prospective observational study from January to December 2017. Patients taking lipid lowering agents were excluded. A detailed medical history was obtained and clinical examination was performed. Serum total cholesterol (STC) and its fractions [low-and high-density lipoprotein] and triglyceride levels were measured in the morning of the first day after admission and then once weekly. The primary outcomes of the study were in-hospital mortality, and hospital stay and hypocholesterolemia were defined as STC levels < 50 mg/dL. Manne-Whitney U and chi-squared tests were used for data analysis, and significance level was set at p<0.05. In this study, 78.4% (CI 95%: 67.3-87.1) of patients had hypocholesterolemia. During the study period, 21.6% (CI 95%: 12.9- 32.7) of patients died. All lipid (except TG) concentrations continuously decreased in deceased sepsis patients but increased in recovering patient (p value for STC (p=0.004), LDL (p=0.006), HDL (p=0.010), and TG (p=0.052)). The serum lipids concentration was not associated with length of hospital stay (p value for STC (p=0.524), LDL (p=0.813), HDL (p=0.799) and TG (p=0.581)). In this study it was found that the additional decline of lipid profile was significantly associated with increased mortality rate of sepsis patients. Thus, the clinically termed 'the lipaemia of sepsis' is not true in all situations.
在脓毒症患者的临床管理中，很少对血脂水平进行检测。脓毒症会导致脂质代谢发生显著变化。本研究的目的是确定脓毒症治疗期间血浆脂质浓度的变化是否与临床结局相关。在本研究中，从2017年1月至12月，74名成年脓毒症患者被纳入这项前瞻性观察性研究。服用降脂药物的患者被排除在外。获取了详细的病史并进行了临床检查。在入院后第一天早晨测量血清总胆固醇（STC）及其组分[低密度和高密度脂蛋白]以及甘油三酯水平，然后每周测量一次。该研究的主要结局是住院死亡率，住院时间和低胆固醇血症定义为STC水平<50mg/dL。采用曼-惠特尼U检验和卡方检验进行数据分析，显著性水平设定为p<0.05。在本研究中，78.4%（95%CI：67.3-87.1）的患者存在低胆固醇血症。在研究期间，21.6%（95%CI：12.9-32.7）的患者死亡。在死亡的脓毒症患者中，所有脂质（除甘油三酯外）浓度持续下降，但在康复患者中升高（STC的p值（p=0.004），低密度脂蛋白（p=0.006），高密度脂蛋白（p=0.010）和甘油三酯（p=0.052））。血清脂质浓度与住院时间无关（STC的p值（p=0.524），低密度脂蛋白（p=0.813），高密度脂蛋白（p=0.799）和甘油三酯（p=0.581））。在本研究中发现，脂质水平的进一步下降与脓毒症患者死亡率增加显著相关。因此，临床上所谓的“脓毒症性脂血症”并非在所有情况下都成立。
