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Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock
Ana Carolina G Bermudes1, Werther B de Carvalho1, Patricia Zamberlan2
1Pediatric Critical Care Unit, Instituto da Criança da Faculdade de Medicina, São Paulo University, São Paulo, Brazil.
Insights
Critically ill children with severe sepsis/septic shock show altered lipid profiles, with lower cholesterol and lipoproteins. Lipid levels improved as inflammation decreased, indicating a link between inflammation and lipid changes in pediatric intensive care unit patients.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Biochemistry
- Infectious Diseases
Background:
- Systemic inflammatory response syndrome (SIRS) in critically ill children significantly impacts metabolic processes.
- Understanding lipid profile alterations in pediatric sepsis is crucial for patient management.
- Limited data exists on the relationship between inflammatory intensity and lipid changes in pediatric intensive care unit (PICU) patients.
Purpose of the Study:
- To investigate the relationship between the intensity of the inflammatory response and lipid profile changes in critically ill pediatric patients with severe sepsis/septic shock.
- To evaluate alterations in total cholesterol, HDL, LDL, triacylglycerols, and apolipoproteins during severe sepsis/septic shock.
Main Methods:
- A prospective, observational study conducted in a 15-bed PICU.
- Lipid profiles of 40 pediatric patients with severe sepsis/septic shock were analyzed on days 1 and 7 of hospitalization.
- C-reactive protein served as the systemic inflammation marker; 42 healthy pediatric patients formed the control group.
Main Results:
- On day 1, PICU patients exhibited significantly lower total cholesterol, HDL, and LDL, with higher triacylglycerols compared to controls.
- A significant increase in total cholesterol, HDL, LDL, and apolipoprotein levels was observed from day 1 to day 7.
- Lower serum lipoproteins and apolipoproteins were negatively correlated with C-reactive protein levels.
Conclusions:
- Severe sepsis/septic shock in children is associated with reduced serum lipoproteins and apolipoproteins.
- Improving inflammatory response correlated with increased levels of total cholesterol, HDL, LDL, and apolipoproteins.
- A direct relationship exists between lipid profile changes and inflammation intensity in critically ill pediatric patients.
Objectives:
Limited knowledge exists regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome. The aim of this study was to evaluate the relationship between the intensity of the inflammatory response and changes in the lipid profiles of critically ill pediatric patients admitted to a pediatric intensive care unit (PICU) with severe sepsis/septic shock.
Methods:
This was a prospective and observational study at a 15-bed PICU at a public university hospital. We analyzed the lipid profiles of 40 patients with severe sepsis/septic shock admitted to the PICU on the first and seventh days of hospitalization. C-reactive protein was used as a marker for systemic inflammation. Forty-two pediatric patients seen in the emergency department and without systemic inflammatory response syndrome were used to provide control values.
Results:
On day 1 of admission to the PICU, the patients had significantly lower levels of total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) as well as higher concentrations of triacylglycerols compared with the control group. There was a significant increase in the TC, HDL, LDL, and apolipoprotein levels from day 1 to day 7 of the study.
Conclusions:
During severe sepsis/septic shock, we found lower serum levels of lipoproteins and apolipoproteins, and these were negatively correlated with C-reactive protein. As the inflammatory response improved, the levels of TC, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation.
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