Relationship between liver dysfunction, lipoprotein concentration and mortality during sepsis.

Area of Science:

• Critical Care Medicine
• Hepatology
• Lipid Metabolism

Background:

• High-density lipoproteins (HDLs) possess protective endothelial functions.
• Low HDL cholesterol (HDL-C) is linked to increased mortality in sepsis and chronic liver failure.
• Sepsis-associated liver dysfunction requires further characterization.

Purpose of the Study:

• To investigate the relationship between liver dysfunction, lipoprotein levels, and mortality in intensive care unit (ICU) patients with sepsis.
• To characterize sepsis-associated liver dysfunction in the ICU setting.

Main Methods:

• Prospective observational study in a university hospital ICU.
• Inclusion of consecutive patients admitted for septic shock or sepsis.
• Assessment of total cholesterol, HDL-C, LDL-C, and triglyceride levels at admission.
• Definition of sepsis-associated liver dysfunction using serum bilirubin or liver enzyme concentrations.
• Prospective assessment of short-term and one-year outcomes.

Main Results:

• 15% of 219 septic patients had liver dysfunction at admission.
• Low lipoprotein concentrations correlated with Day 28 mortality in the overall cohort.
• Sepsis-associated liver dysfunction at admission was associated with increased mortality.
• Patients with liver dysfunction had lower HDL-C (0.31 vs. 0.48 mmol/L, p=0.0079) but HDL-C did not correlate with outcomes in this subgroup.
• No correlation found between lipoprotein levels and liver dysfunction markers.

Conclusions:

• Sepsis-associated liver dysfunction at ICU admission predicts higher mortality and is associated with lower HDL-C.
• In septic patients with liver dysfunction, HDL-C levels did not predict mortality.
• Further research is needed to elucidate the interplay between lipoproteins and liver dysfunction in sepsis.