Department of Anesthesiology and Reanimation, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
Department of Nutrition and Dietetics, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Turkey.
Clin Nutr. 2021 Jul;40(7):4569-4578. doi: 10.1016/j.clnu.2021.05.037. Epub 2021 Jun 12.
BACKGROUND & AIMS: Intravenous lipid emulsions in parenteral nutrition may cause different metabolic responses and immune effects in critically ill patients with sepsis. The aim of this study is to investigate the effects of different lipid emulsions on changes in concentrations of adipokine and cytokine and their relationship with mortality in patients.
Patients enrolled in this prospective, single-center, observational cohort study, were estimated to require more than ten days of parenteral nutrition. They were treated with soybean oil-based or olive oil-based parenteral lipid emulsions. Adipokine and cytokine concentrations of septic patients were determined at enrollment and ten days after, in accordance with the diagnostic criteria of SEPSIS-3. The concentrations levels were measured in an enzyme-linked immunosorbent assay. Mortality was analyzed using the Kaplan-Meier method and Cox regressions.
Over a 25-month period, 145 patients were assessed for eligibility and consequently, 40 patients were analyzed. On admission, both groups had comparable physiological scores, comorbidities, malnutrition risk, anthropometric measurements, metabolic/hematologic biomarkers and concentrations of adipokines and cytokines (p > .05). Serum leptin, resistin, and cytokines (IL-6, IL-10, IL-1β and TNF-α) decreased significantly in the entire cohort over ten days following sepsis (p < .05). Serum resistin decreased in both olive oil-based and soybean oil-based lipid emulsions groups. Serum adiponectin only decreased in soybean oil-based lipid emulsions group (p < .05). There was association between survival and percentage changes in adiponectin, resistin and visfatin concentrations (log rank test: p < .05).
Adipokine and cytokine responses are affected by medical nutritional therapy in the sepsis process and adipokines may represent functional prognostic biomarkers in critically ill patients with sepsis.
肠外营养中的静脉脂肪乳剂可能会导致脓毒症危重症患者产生不同的代谢反应和免疫效应。本研究旨在探讨不同脂肪乳剂对患者脂联素和细胞因子浓度变化的影响及其与死亡率的关系。
本前瞻性、单中心、观察性队列研究纳入预计需要肠外营养 10 天以上的患者，给予大豆油或橄榄油基肠外脂肪乳剂治疗。根据 SEPSIS-3 的诊断标准，在入组时和 10 天后测定脓毒症患者的脂联素和细胞因子浓度。采用酶联免疫吸附试验测定浓度水平。采用 Kaplan-Meier 方法和 Cox 回归分析死亡率。
在 25 个月的时间内，对 145 名患者进行了评估，最终纳入 40 名患者进行分析。入院时，两组患者的生理评分、合并症、营养不良风险、人体测量学指标、代谢/血液学标志物以及脂联素和细胞因子浓度均无差异（p>.05）。在整个队列中，入院后 10 天，血清瘦素、抵抗素和细胞因子（IL-6、IL-10、IL-1β和 TNF-α）均显著降低（p<.05）。橄榄油基和大豆油基脂肪乳剂组的血清抵抗素均降低。只有大豆油基脂肪乳剂组的血清脂联素降低（p<.05）。脂联素、抵抗素和内脂素浓度的变化百分比与生存存在相关性（对数秩检验：p<.05）。
在脓毒症过程中，脂联素和细胞因子的反应受医学营养治疗的影响，脂联素可能是脓毒症危重症患者的功能性预后生物标志物。
