Chen Xiancheng, Li Haoran, Huang Shuting, Chen Ming, Huang Shijie, Zhu Zhanghua, You Yong, Xu Guifang, Wang Yan, Wang Rong, Yu Wenkui
Department of Critical Care Medicine, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Precision Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Shock. 2025 Sep 1;64(3):322-331. doi: 10.1097/SHK.0000000000002634.
Persistent inflammation, immunosuppression, and catabolism syndrome (PIICS) is a severe condition that occurs in patients in intensive care units (ICUs), and it is associated with high morbidity and mortality. This prospective cohort study investigated the dynamic changes in lipoproteins, lipidomics, and gut microbiota from days 1 to 7 posthospitalization for PIICS to elucidate their roles in the pathophysiology of PIICS. Patients admitted to the ICU were enrolled, and blood and fecal samples were collected 1 day and 7 days after admission. Lipidomic profiles were analyzed using liquid chromatography with tandem mass spectrometry, and gut microbiota composition was assessed using 16S RNA sequencing Patients who subsequently developed PIICS had lower levels of high-density lipoprotein, low-density lipoprotein, and other lipoproteins than those in patients without PIICS. Most of the lipids and gut microbes decreased significant in PIICS-2 compared to PIICS-1. Day 7 high-density lipoprotein levels were predictive of PIICS diagnosis and prognosis, and were correlated with inflammatory marker levels and 30-day survival. These findings suggest an interplay between lipid metabolism and gut microbiota in PIICS development; therefore, microbiota-mediated regulation of lipid metabolism is a potential therapeutic target for PIICS. This study provides novel insights into the complex mechanisms underlying PIICS and highlights the importance of further research into targeted interventions for critically ill patients with this syndrome.
持续性炎症、免疫抑制和分解代谢综合征（PIICS）是重症监护病房（ICU）患者中出现的一种严重病症，与高发病率和死亡率相关。这项前瞻性队列研究调查了PIICS患者住院后第1天至第7天脂蛋白、脂质组学和肠道微生物群的动态变化，以阐明它们在PIICS病理生理学中的作用。纳入入住ICU的患者，在入院后第1天和第7天采集血液和粪便样本。使用液相色谱串联质谱分析脂质组学谱，使用16S RNA测序评估肠道微生物群组成。随后发生PIICS的患者的高密度脂蛋白、低密度脂蛋白和其他脂蛋白水平低于未发生PIICS的患者。与PIICS-1相比，PIICS-2中的大多数脂质和肠道微生物显著减少。第7天的高密度脂蛋白水平可预测PIICS的诊断和预后，并与炎症标志物水平和30天生存率相关。这些发现表明脂质代谢与肠道微生物群在PIICS发生过程中相互作用；因此，微生物群介导的脂质代谢调节是PIICS的潜在治疗靶点。本研究为PIICS潜在的复杂机制提供了新的见解，并强调了进一步研究针对该综合征重症患者的靶向干预措施的重要性。
