Incidence and risk factors of hypertriglyceridemia in the ICU

Introduction

A linear correlation between serum triglyceride and risk of intensive care mortality was identified. Various clinical and metabolic situations such as sepsis, renal failure, hepatic failure and administration of certain drugs have been associated with hypertriglyceridemia (HTG). It is well known that HTG is associated with acute pancreatitis. Development of systemic inflammatory response syndrome or the onset of organ system dysfunction are the complications of severe acute pancreatitis that is an episode of acute pancreatitis. The aim of this study was to determine the incidence of HTG in patients receiving artificial nutrition in an ICU, to describe their characteristics and to establish the relevance of risk factors associated with HTG.

Methods

A prospective, observational, cohort study performed in a general ICU of Toulouse University Hospital, Toulouse, France from 1 May 2007 to 31 July 2008. We included consecutive intensive care patients with an initial serum triglyceride level less than 3 mmol/l who received at least 7 days of artificial nutrition and with at least three biochemical serum triglyceride analyses with a 1-week interval. The chi-square test and a multivariate logistic regression model were performed for statistical analysis. A total of 17 clinical factors were studied as independent variables.

Results

A total of 107 patients were included in the study. Administration of lipid was 0.83 ± 0.36 g/kg/day. The incidence of HTG was calculated as 17.9% per year. Multivariate analysis identified three independent risk factors for HTG: age (P = 0.02; adjusted β-coefficient = -0.83), insulin dosage (P = 0.01; adjusted β-coefficient = 0.83), hepatic failure (P = 0.04; adjusted β-coefficient = 1.27).

Conclusion

The present study showed that ICU-admitted patients receiving artificial nutrition are prone to develop HTG. Hepatic failure and the insulin infusion rate were the most important risk factors for HTG. Age had a protective effect. Our results raise three important matters: (1) serum triglyceride measurement is necessary in seriously ill patients receiving artificial nutrition; (2) elevated triglycerides reflect the degree of insulin resistance and severity of critical illness; and (3) the hypertriglyceridemic profile of young patients admitted to the ICU is very important to consider.