Pronounced dyslipoproteinemia in intensive care patients

Concentrations of triglycerides (TG) and cholesterol in serum and in lipoproteins were determined in two groups of intensive care patients. Group I included 17 moderately ill, postelective surgery patients, and group II, 23 critically ill patients. All were studied in an intensive care situation. The lipoprotein lipid concentrations were compared with those from a group of healthy men and women. In group I, both TG and cholesterol concentrations in serum were decreased, whereas in group II, only cholesterol concentration was lowered and the TG concentration was close to control values. In the lipoproteins, marked abnormalities were found. The most striking was an increase in low density lipoprotein (LDL)-TG and a decrease in high density lipoprotein (HDL)-cholesterol concentrations. In group II, 5/18 males had a LDL-TG concentration above any control value and 21/23 had a HDL-cholesterol concentration below any value in the control group. In addition, the alpha-lipoprotein (HDL) band on electrophoresis was often grossly abnormal with a broad or double-peaked band. There was a highly significant negative correlation between LDL-TG and HDL-cholesterol concentrations. Patients who received conventional treatment with insulin or heparin had similar lipid concentrations as those not given these drugs. The time effect on lipoprotein changes was analyzed in 11 patients, from whom samples were drawn repeatedly during the intensive care period. A tendency was found for LDL-TG to increase and HDL-cholesterol to decrease with time. The mechanisms causing the lipoprotein changes are not presently known; however, possible explanations include liver function impairment, gastrointestinal tract paralysis, physical inactivity, the catabolic state as such, and combinations.