Presepsis biomarker: high-density lipoprotein

Introduction

Delay in diagnosis and initiation of antibiotic treatment has been shown to increase mortality. Biomarkers can play an important role in diagnosis and prognosis of sepsis. We aimed to evaluate the correlation between septicemia and high-density lipoprotein (HDL) level in burned patients.

Methods

A prospective study conducted at Al-Sadr teaching hospital, Maysan, Iraq, during the period from April to September 2013. Blood samples were collected from patients every other day to measure the level of HDL and triglycerides. Other blood samples were collected in blood culture tubes for culturing to verify septicemia depending on the clinical evidence.

Results

Seventy-five patients (Table 1) were admitted consecutively into the burn unit, 35 of them (46%) developed septicemia and 11 of the 35 patients died. All dead patients had HDL value <5 mg/dl 1 or 2 days before dying since our blood samples were collected every 2 days (Tables 2 and 3). Other laboratory tests such as WBCs, platelet account, albumin level, and so forth were made to confirm sepsis (Table 4). A comparison between the level of lipid profile before and after sepsis showed a significant drop in HDL level during the onset of sepsis (Table 5). We also found that patients with HDL value <15 mg/dl were at high risk of developing sepsis.

Table 1 Characteristics of patients

Table 2 Lipid profile for all 75 patients at the onset of thermal injury during the first day of admission: all patients were with a normal range of HDL, triglycerides and cholesterol

Table 3 Lipid profile at the onset of sepsis showed that HDL level dropped to less than 15 mg/dl with range (4 to 13 mg/dl): elevation in triglyceride level out of normal range with no significant change in cholesterol level

Table 4 Levels of urea, creatinine, albumin, WBC, platelets during onset of sepsis: most patients developed hypoalbuminemia and thrombocytopenia

Table 5 Comparison between level of lipid profile before and after sepsis showed the significant dropping in HDL level during onset of sepsis

Conclusion

There was a strong correlation between HDL level and septicemia in burn patients. The HDL value is a good biomarker for sepsis; it decreases below normal level and continues to diminish and reach an immeasurable level at the advanced stage of septicemia.