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Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis

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Abstract

Background and aim

Infective endocarditis (IE) is a complex thrombo-inflammatory disorder, the pathogenesis of which involves a multifaceted interplay between vascular damage and bacterial virulence factors. This study aimed to assess the prognostic role of small dense low-density lipoprotein (sdLDL) cholesterol in patients with IE and its correlation with various disease-related features.

Methods

A cohort of 198 patients with definite IE was included in this study. Clinical, laboratory, and echocardiographic parameters were meticulously analyzed, with a specific focus on comorbidities. sdLDL levels were measured using stored plasma samples obtained upon admission during the acute phase of the disease.

Results

The median level of sdLDL was 24 mg/dL [with an interquartile range of 17.9–35.2 mg/dL], and this value showed a statistically significant positive correlation with LDL/HDL cholesterol and triglycerides (p < 0.01 for all). Furthermore, a remarkable inverse correlation between C-reactive protein and D-dimer levels was observed (p < 0.0001). Univariate analysis revealed that patients with sdLDL levels ≤ 24 mg/dL had 2.75 times higher odds of in-hospital mortality (95% Confidence Interval:1.08–6.98, p = 0.031). In addition, nonsurvivors had significantly lower median sdLDL levels (19.7 vs. 26.0 mg/dL, p = 0.041). Lower sdLDL levels were also associated with embolic complications, larger vegetation size, and positive blood cultures for Staphylococci (p = 0.019, p = 0.022, and p < 0.001, respectively).

Conclusions

Low circulating sdLDL levels in the acute phase of IE were significantly correlated with unfavorable clinical outcomes. These results suggest that the sdLDL level may serve as an important marker of disease severity in IE and may represent a link between vascular damage, embolic complications, and disease progression.

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All data generated or analyzed during this study are included in this published article.

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Acknowledgements

We would like to thank Ahsanullah Unar for revising scientific English. Members of the Monaldi Hospital Cardiovascular Infection Study Group: Emanuele Durante-Mangoni MD, PhD, Domenico Iossa PhD, Lorenzo Bertolino MD, Maria Paola Ursi MD, Fabiana D’Amico BSc, Fabian Patauner MD, Raffaella Gallo MD, Anna Maria Peluso MD, Oriana Infante MD, Rosa Zampino MD, PhD (Internal Medicine); Mariano Bernardo MSc, Giuseppe Ruocco MSc (Microbiology); Giovanni Dialetto MD, Franco Enrico Covino MD, Sabrina Manduca MD, PhD (Echocardiography); Alessandro Della Corte MD, PhD, Luca Salvatore De Santo MD, PhD, Antonio Carozza MD, PhD, Marisa De Feo MD, PhD (Cardiac Surgery); Gerardo Nigro MD (Electrophysiology); Maria Luisa De Rimini MD (Nuclear Medicine); Nicola Galdieri MD (Intensive Care).

Funding

This work was supported by the University of Campania ‘L. Vanvitelli’ Research Funds (grant Ricerca di Ateneo) to EDM.

Author information

Authors and Affiliations

  1. Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Napoli, Italy

    Filomena Boccia, Anna Maria Peluso, Emilio Palmieri & Rosa Zampino

  2. Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Napoli, Italy

    Domenico Iossa, Lorenzo Bertolino, Fabian Patauner & Emanuele Durante-Mangoni

  3. Unit of Infectious and Transplant Medicine, A.O.R.N. Ospedali dei Colli-Ospedale Monaldi, Naples, Italy

    Domenico Iossa, Rosa Zampino & Emanuele Durante-Mangoni

  4. Unit of Clinical Biochemistry, A.O.R.N. Ospedali dei Colli, Naples, Italy

    Silvia Leonardi & Rita Boenzi

  5. Ospedale Monaldi, Piazzale Ettore Ruggieri, 80131, Naples, Italy

    Emanuele Durante-Mangoni

Authors
  1. Filomena Boccia
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  2. Domenico Iossa
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  3. Silvia Leonardi
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  4. Anna Maria Peluso
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  5. Lorenzo Bertolino
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  6. Fabian Patauner
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  7. Emilio Palmieri
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  8. Rita Boenzi
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  9. Rosa Zampino
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  10. Emanuele Durante-Mangoni
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Consortia

For the Monaldi Hospital Cardiovascular Infection Study Group

  • Emanuele Durante-Mangoni
  • , Domenico Iossa
  • , Lorenzo Bertolino
  • , Filomena Boccia
  • , Fabiana D’Amico
  • , Fabian Patauner
  • , Filomena Boccia
  • , Oriana Infante
  • , Rosa Zampino
  • , Mariano Bernardo
  • , Giuseppe Ruocco
  • , Giovanni Dialetto
  • , Filomena Boccia
  • , Sabrina Manduca
  • , Filomena Boccia
  • , Luca Salvatore De Santo
  • , Antonio Carozza
  • , Marisa De Feo
  • , Gerardo Nigro
  • , Maria Luisa De Rimini
  •  & Nicola Galdieri

Contributions

FB, EDM and RZ, worked on concept/design of the study; AMP, EP collected clinical data; SL and RB performed laboratory tests; FP e LB updated references, DI collected clinical specimens and conducted statistical analysis; RZ and FB drafted the manuscript; RZ and EDM critically revised the manuscript, which was read and approved by all authors.

Corresponding author

Correspondence to Emanuele Durante-Mangoni.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose relevant to the content of this study. EDM received grant support and personal fees, outside of this work, from Roche, Pfizer, MSD, Genentech, Angelini, Shionogi, Menarini, Gilead, Bio-Merieux, Abbvie, InfectoPharm, Sanofi-Aventis, Medtronic, and DiaSorin. RZ received grant support and/or personal fees outside of this work from Gilead and InfectoPharm. FB received personal fees, outside of this work, from Menarini.

Ethical approval and consent to participate

This study was approved by the Ethics Committee of the University of Campania “Luigi Vanvitelli” and the AORN Ospedali dei Colli (Prot. N. AOC 0011110/2020). All patients provided informed consent for blood sampling and the anonymous use of their clinical data.

Consent for publication

Not applicable.

Additional information

The members of the Monaldi Hospital Cardiovascular Infection Study Group are mentioned in “Acknowledgements” section.

Supplementary Information

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Boccia, F., Iossa, D., Leonardi, S. et al. Clinical correlates of circulating small dense low-density lipoproteins in acute infective endocarditis. Infection (2023). https://doi.org/10.1007/s15010-023-02139-z

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