Alterations in serum lipid profile in critically ill septic patients: a prospective study

Aims and Objectives: Sepsis results in severe lipid metabolic alterations. Lipids exert important immunomodulatory actions during infection. We aim to investigate whether serum lipid changes early in sepsis are associated with severity and outcome. Methods: In a prospective study, serum total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides (TG) were determined in 82 critically ill patients (49 males, age 65±14 years, APACHE II 23±7, SOFA 10±3) at sepsis onset and one week after, and in 82 age and gender-matched healthy controls. Results: Upon enrollment, TC, HDL and LDL were significantly lower and TG were higher in patients compared to controls (p<0.001). TC and LDL increased one week after sepsis onset (21% and 30% increase compared to baseline, respectively) while HDL and TG did not change significantly. Baseline TG were significantly higher in patients presenting with septic shock (N=30) compared to patients with sepsis (N=52) (221±109mg/dL vs 166±97mg/dL, p=0.03), while baseline TC and LDL were significantly higher in survivors (N=58) than nonsurvivors at 28 days (N=24) (122±36mg/dL vs 97±41mg/dL, p=0.015 and 61±38mg/dL vs 38±23mg/dL, p=0.002, respectively). Absolute changes in lipids during the first week of sepsis did not differ between patients with sepsis and septic shock. However, TG presented higher kinetics in survivors (34% increase) compared to nonsurvivors (19% decrease). Baseline HDL correlated negatively and TG positively with SOFA, lactate, C-reactive protein and procalcitonin. Conclusions: Critically ill septic patients exhibit significant alterations of serum lipids associated with sepsis severity and outcome.