HDL Cholesterol Efflux is Impaired in Older Patients with Early Sepsis: A Subanalysis of a Prospective Pilot Study.

Abstract

BACKGROUND:

Proper functioning of high-density lipoprotein (HDL) is necessary for protection against sepsis. However, previous work has demonstrated that HDL becomes oxidized and dysfunctional (Dys-HDL) during sepsis. Older (aged >65 years) patients are at particularly high risk of sepsis and poor outcomes from sepsis.

STUDY OBJECTIVE:

The aim of the study was to compare functional properties of HDL (cholesterol efflux capacity and paraoxonase enzyme 1 [PON-1] activity) and Dys-HDL between older (aged >65 years) sepsis patients and older healthy volunteers.

METHODS:

This was a subanalysis of a prospective study in which patients with sepsis were prospectively enrolled from the emergency department within the first 24 h. Serum and plasma samples were drawn from septic patients and age- and sex-matched control subjects. Percent cholesterol efflux, HDL inflammatory index, and PON1 activity were measured. Data were analyzed using Student t test or Wilcoxon rank-sum test.

RESULTS:

Ten sepsis and 10 healthy controls were analyzed. Mean age of sepsis patients (80 ± 2 years [SD]) and control subjects (77 ± 2 years) was similar (P = 0.31). Mean systolic blood pressures were significantly different in sepsis patients (113 ± 8 mmHg) compared with controls (133 ± 6 mmHg) (P = 0.049). Median SOFA scores for sepsis patients were 5.5 (interquartile range [IQR] 4-9). Mean percent cholesterol efflux was significantly reduced in sepsis (24.1 ± 1.2%) compared with controls (31.5 ± 1.0%) (P < 0.001). HDL inflammatory index was also significantly elevated in septic patients (1.63, IQR 1.3-2.34) compared with controls (0.62, IQR 0.56-0.67) (P < 0.001). However, PON1 activity was not significantly different between septic patients (70.3 ± 16.3 nmol/min/mL) and control subjects (88.8 ± 18.3 nmol/min/mL).

CONCLUSIONS:

Cholesterol efflux capacity seems to be significantly impaired in sepsis patients who also exhibited a higher index of Dys-HDL. The findings suggest that HDL function may be impaired in older individuals with sepsis.

• Authors: Faheem W Guirgis, Christiaan Leeuwenburgh, Victor Grijalva, Jennifer Bowman, Colleen Kalynych, Lyle Moldawer, Frederick A Moore, Srinivasa T Reddy
• Journal: Shock (Augusta, Ga.) (Shock) Vol. 50 Issue 1 Pg. 66-70 (07 2018) ISSN: 1540-0514 [Electronic] United States
• PMID: 29049133 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Cholesterol, HDL

Topics

• Aged
• Aged, 80 and over
• Blood Pressure (physiology)
• Cholesterol, HDL (metabolism)
• Female
• Humans
• Male
• Pilot Projects
• Prospective Studies
• Sepsis (metabolism)
• Shock, Septic (metabolism)