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Cholesterol levels and long-term rates of community-acquired sepsis
Faheem W Guirgis1, John P Donnelly2,3, Sunita Dodani4,5
1Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, FL, USA.
Insights
Low LDL-C levels are linked to increased long-term sepsis risk, while HDL-C levels show no association. This finding is crucial for understanding sepsis development and prevention strategies.
Area of Science:
- Cardiology
- Epidemiology
- Metabolic Disorders
Background:
- Dyslipidemia, characterized by abnormal cholesterol levels, is a known cardiovascular disease risk factor.
- Elevated low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C) are associated with acute coronary events.
- Previous studies suggest a link between low cholesterol and adverse outcomes in acute sepsis.
Purpose of the Study:
- To investigate the relationship between baseline cholesterol levels (HDL-C and LDL-C) and the long-term incidence of sepsis.
- To determine if specific lipid profiles predict future sepsis events in a large adult cohort.
Main Methods:
- Utilized data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, including 29,690 adults.
- Defined the primary outcome as the first sepsis event, identified by infection-related hospitalization with ≥2 systemic inflammatory response syndrome criteria within 28 hours.
- Employed Cox proportional hazards models to analyze associations between quartiles of HDL-C and LDL-C and sepsis events, adjusting for covariates.
Main Results:
- Serum HDL-C levels were not significantly associated with long-term sepsis rates across different quartiles.
- Lower baseline LDL-C levels (Q1 and Q2) were significantly associated with increased long-term rates of sepsis compared to the highest quartile (Q4).
- Hazard ratios indicated a dose-response relationship between lower LDL-C and higher sepsis risk.
Conclusions:
- Low LDL-C levels are associated with a higher risk of developing community-acquired sepsis over the long term.
- HDL-C levels do not appear to be a significant predictor of long-term sepsis risk.
- Findings suggest that LDL-C may play a role in sepsis susceptibility.
Background:
Dyslipidemia is a risk factor for cardiovascular disease, with elevated low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C) recognized as risk factors for acute coronary events. Studies suggest an association between low cholesterol levels and poor outcomes in acute sepsis. We sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis.
Methods:
We used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, a population-based cohort of 30,239 community-dwelling adults. The primary outcome was first sepsis event, defined as hospitalization for an infection with the presence of ≥2 systemic inflammatory response syndrome criteria (abnormal temperature, heart rate, respiratory rate, white blood cell count) during the first 28 hours of hospitalization. Cox models assessed the association between quartiles of HDL-C or LDL-C and first sepsis event, adjusted for participant demographics, health behaviors, chronic medical conditions, and biomarkers.
Results:
We included 29,690 subjects with available baseline HDL-C and LDL-C. There were 3423 hospitalizations for serious infections, with 1845 total sepsis events among 1526 individuals. Serum HDL-C quartile was not associated with long-term rates of sepsis (hazard ratio (HR) (95% CI): Q1 (HDL-C 5-40 mg/dl), 1.08 (0.91-1.28); Q2 (HDL-C 41-49 mg/dl), 1.06 (0.90-1.26); Q3 (HDL-C 50-61 mg/dl), 1.04 (0.89-1.23); Q4, reference). However, compared with the highest quartile of LDL-C, low LDL-C was associated with higher rates of sepsis (Q1 (LDL-C 3-89 mg/dl), 1.30 (1.10-1.52); Q2 (LDL-C 90-111 mg/dl), 1.24 (1.06-1.47); Q3 (LDL-C 112-135 mg/dl), 1.07 (0.91-1.26); Q4, reference).
Conclusion:
Low LDL-C was associated with higher long-terms rates of community-acquired sepsis. HDL-C level was not associated with long-term sepsis rates.
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