Serum lipids analysis in septic shock patients

Objective

Not much is currently known about lipoproteins and its role in septic shock. Many studies have recently implicated lipoproteins with the innate immunity against lipopolysacchardie. There are many questions of whether low values of serum lipoproteins are related to an impaired innate immunity against endotoxin and to a poor prognosis. We conducted a prospective study to analyze serum lipids, glucose, triglycerides and C-reactive protein in septic shock patients and to evaluate its possible relation with outcome.

Design

A prospective observational analysis of serum of patients meeting the criteria for septic shock.

Setting

A 28-bed medico-surgical ICU in a university hospital.

Patients

Eighteen patients were analyzed in the study.

Materials and methods

We selected all consecutive patients who met the criteria for septic shock in our ICU and we collected blood samples for analysis on days 1, 3, 6, 9, and 12 or until death. We analyzed total cholesterol, cholesterol fractions (high density lipoprotein [HDL], low density lipoprotein, very low density lipoprotein), triglycerides, glycemia and C-reactive protein (as a marker of inflamation).

Statistical analysis

All results are presented as the mean with standard deviation. For analysis we divided patients into survivors and nonsurvivors at day 12. We performed a paired Student's t test for differences in continuous variables, and correlation coefficients were determined according to multiple-level regression analysis. P < 0.05 was considered significant.

Results

Our mortality rate was 60%. We had 10 patients in the nonsurvivor group and eight patients as survivors. The two groups had similar APACHE II scores (nonsurvivors 26 ± 6; survivors 24 ± 5; NS). At day 1 there were no statistical differences for any of the substances analyzed. From day 3 onwards, we achieved significant statistical differences between survivors and nonsurvivors for total cholestherol, HDL fraction, trigycerides, glycemia and C-reactive protein. The correlations of C-reactive protein with the HDL fraction, total cholesterol, triglycerides and glycemia were not good. As independent variables, we found only glycemia and trigycerides.

Conclusions

In our patients, hypocholesterolemia, low levels of HDL fraction, hypertriglyceridemia and hyperglicemia were statistically significant related to a poor prognosis. C-reactive protein did not show a good correlation with other parameters.