Exploring the Predictive Ability of Dysfunctional High-Density Lipoprotein for Adverse Outcomes in Emergency Department Patients with Sepsis: A Preliminary Investigation.

Abstract

BACKGROUND:

High density lipoprotein (HDL) can be readily oxidized in inflammatory conditions and exhibit pro-inflammatory and dysfunctional (Dys-HDL) characteristics. We hypothesize that Dys-HDL may predict adverse outcomes and correlate with inflammatory cytokines in sepsis.

METHODS:

Emergency department (ED) patients with sepsis were enrolled. Blood was drawn at enrollment and after 48 h. Dys-HDL, expressed as HDL inflammatory index (HII), and cytokines were measured. Multivariable logistic regression was used to determine the predictive ability of Dys-HDL for adverse outcomes (death, discharge to hospice, or nursing home).

RESULTS:

Thirty-five patients were included in the study. HII was not significantly different at baseline or 48 h between patients with adverse outcomes versus those without. However, there was a significant difference in change in HII over the first 48 h between those with adverse outcomes (+0.21, 95% CI -0.13 to 0.31) versus those without (-0.11, 95% CI -1 to 0.11) (P = 0.025). Logistic regression revealed increasing HII to be an independent predictor of adverse outcomes (OR 5.2, 95% CI 1.1-25.1 P = 0.040). Of the 24 patents with cytokine measurements at both time points, significant inverse correlations between change in HII and change in GRO (rs = -0.52, P = 0.0088) and monocyte chemotactic protein-1 (rs = -0.61, P = 0.0014) concentrations over 48 h were observed.

CONCLUSION:

Increasing Dys-HDL concentrations in the first 48 h of sepsis are associated with an ongoing inflammatory response and adverse clinical outcomes. Early changes in HII may be a potential biomarker in ED patients admitted with sepsis.

• Authors: Faheem W Guirgis, Sunita Dodani, Lyle Moldawer, Christiaan Leeuwenburgh, Jennifer Bowman, Colleen Kalynych, Alan E Jones, Srinivasa T Reddy, Frederick A Moore
• Journal: Shock (Augusta, Ga.) (Shock) Vol. 48 Issue 5 Pg. 539-544 (11 2017) ISSN: 1540-0514 [Electronic] United States
• PMID: 28452909 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, N.I.H., Extramural)

Chemical References

• Biomarkers
• Chemokine CCL2
• Cholesterol, HDL
• Lipoproteins, HDL

Topics

• Biomarkers (metabolism)
• Chemokine CCL2 (metabolism)
• Cholesterol, HDL (metabolism)
• Emergency Service, Hospital
• Humans
• Lipoproteins, HDL (metabolism)
• Logistic Models
• Oxidation-Reduction
• Sepsis (metabolism)