Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Anesthesiology and Critical Care Medicine, Bichat-Claude Bernard Hospital, Paris, France.
Réunion Island University, French Institute of Health and Medical Research (INSERM), Diabetes atherothrombosis Réunion Indian Ocean (DéTROI), CYROI Plateform, Saint-Denis de La Réunion, Saint Denis, France.
PLoS One. 2022 Aug 22;17(8):e0272352. doi: 10.1371/journal.pone.0272352. eCollection 2022.
High-density lipoproteins (HDLs) are synthesized by the liver and display endothelioprotective properties, including anti-inflammatory, antiapoptotic, antithrombotic and antioxidant effects. In both septic and chronic liver failure patients, a low HDL cholesterol (HDL-C) concentration is associated with overmortality. Whereas sepsis-associated liver dysfunction is poorly defined, the aim of this study was to characterize the relationship between liver dysfunction, lipoprotein concentrations and mortality in septic patients in the intensive care unit (ICU).
A prospective observational study was conducted in a university hospital ICU. All consecutive patients admitted for septic shock or sepsis were included. Total cholesterol, HDL-C, low-density lipoprotein-cholesterol (LDL-C), and triglyceride levels were assessed at admission. Sepsis-associated liver dysfunction was defined as a serum bilirubin≥ 2N or aspartate aminotransferase/alanine aminotransferase concentrations ≥ 2N. Short-term and one-year prognostic outcomes were prospectively assessed.
A total of 219 septic patients were included, and 15% of them presented with sepsis-associated liver dysfunction at admission. Low concentrations of lipoproteins were associated with mortality at Day 28 in the overall population. Sepsis-associated liver dysfunction at admission was associated with overmortality. In this subgroup, patients had a lower HDL-C concentration than patients without hepatic dysfunction (HDL-C = 0.31 [0.25, 0.55] mmol/L vs. 0.48 [0.29, 0.73] mmol/L, p = 0.0079) but there was no relationship with the outcome. Interestingly, no correlation was observed between lipoprotein concentrations and liver dysfunction markers.
Sepsis-associated liver dysfunction at ICU admission is strongly associated with overmortality and is associated with a lower HDL-C concentration. However, in this subgroup of patients, HDL-C concentration had no relationship with mortality. Further exploratory studies are needed to better understand the interaction between lipoproteins and liver dysfunction during sepsis.
高密度脂蛋白（HDLs）由肝脏合成，具有内皮保护特性，包括抗炎、抗凋亡、抗血栓和抗氧化作用。在败血症和慢性肝功能衰竭患者中，低 HDL 胆固醇（HDL-C）浓度与高死亡率相关。虽然与败血症相关的肝功能障碍定义不明确，但本研究旨在描述 ICU 中败血症患者肝功能障碍、脂蛋白浓度与死亡率之间的关系。
在一所大学医院 ICU 进行了一项前瞻性观察性研究。所有因败血症性休克或败血症而入院的连续患者均被纳入。入院时评估总胆固醇、HDL-C、低密度脂蛋白胆固醇（LDL-C）和甘油三酯水平。将血清胆红素≥2N 或天冬氨酸氨基转移酶/丙氨酸氨基转移酶浓度≥2N 定义为败血症相关肝损伤。前瞻性评估短期和一年预后结局。
共纳入 219 例败血症患者，其中 15%入院时存在败血症相关肝损伤。在总体人群中，脂蛋白浓度低与 28 天死亡率相关。入院时的败血症相关肝损伤与死亡率增加相关。在该亚组中，患者的 HDL-C 浓度低于无肝功能障碍患者（HDL-C=0.31[0.25，0.55]mmol/L 比 0.48[0.29，0.73]mmol/L，p=0.0079），但与结局无相关性。有趣的是，脂蛋白浓度与肝功能障碍标志物之间无相关性。
ICU 入院时的败血症相关肝损伤与高死亡率密切相关，与 HDL-C 浓度降低相关。然而，在该患者亚组中，HDL-C 浓度与死亡率无关。需要进一步的探索性研究来更好地理解败血症期间脂蛋白与肝损伤之间的相互作用。
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