Serum lipoproteins: how important are they in septic shock patients? Is there a relation to outcome?
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KeywordsCholesterol Intensive Care Unit Septic Shock Triglyceride Level Tertiary Care Hospital
Decreased concentrations of serum lipoproteins occur early in critically ill patients. Furthermore, very little is known of the role that lipoproteins play in septic shock. Lipoproteins have recently been associated with innate immunity. It is reported that low values of lipoproteins are associated with low innate immunity and poor prognosis. A prospective study was designed to evaluate serum lipoproteins in septic shock patients and to investigate possible relations to the outcome.
A prospective study over a period of 1 year set in a six-bed university hospital intensive care unit and in a five-bed medical intensive care unit of a tertiary care hospital. Eighty-eight patients were included in the study that met the ACCP/SCCM consensus criteria for septic shock. Blood samples were collected from these patients on days 1, 3, 6, 9, 12 and 15 or until discharge or death and were analyzed for total cholesterol, high density lipoprotein (HDL), low density lipoprotein (LDL) and triglycerides. Results are expressed as mean ± standard deviation. Multiple level regression analysis was used.
The group of patients were divided into survivors and nonsurvivors. We had 33 patients in the nonsurvivor group and 55 patients that recovered from their septic shock. The mortality rate was approximately 37.5%. The APACHE II scores for both groups were similar with no significant difference during the study. Admission values of serum lipoproteins showed no significant differences in either group of patients. However, a statistically significant difference was observed between the groups from day 3. Serum cholesterol, HDL levels were significantly lower starting from day 3 and triglyceride levels were significantly higher noted also from day 3 and onwards. All serum lipoproteins showed statistically significant differences between the two groups from day 6 and onwards. LDL showed no significant difference between the two groups.
In our study it was evident that low cholesterol and low HDL levels as well as high triglyceride levels are significantly related to poorer outcome in septic patients. All three variables presented a significant difference between survivors and non-survivors during the study.