Cholesterol levels and long-term rates of community-acquired sepsis

Abstract

BackgroundDyslipidemia is a risk factor for cardiovascular disease, with elevated low-density lipoprotein cholesterol (LDL-C) and decreased high-density lipoprotein cholesterol (HDL-C) recognized as risk factors for acute coronary events. Studies suggest an association between low cholesterol levels and poor outcomes in acute sepsis. We sought to determine the relationship between baseline cholesterol levels and long-term rates of sepsis.MethodsWe used data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, a population-based cohort of 30,239 community-dwelling adults. The primary outcome was first sepsis event, defined as hospitalization for an infection with the presence of ≥2 systemic inflammatory response syndrome criteria (abnormal temperature, heart rate, respiratory rate, white blood cell count) during the first 28 hours of hospitalization. Cox models assessed the association between quartiles of HDL-C or LDL-C and first sepsis event, adjusted for participant demographics, health behaviors, chronic medical conditions, and biomarkers.ResultsWe included 29,690 subjects with available baseline HDL-C and LDL-C. There were 3423 hospitalizations for serious infections, with 1845 total sepsis events among 1526 individuals. Serum HDL-C quartile was not associated with long-term rates of sepsis (hazard ratio (HR) (95% CI): Q1 (HDL-C 5–40 mg/dl), 1.08 (0.91–1.28); Q2 (HDL-C 41–49 mg/dl), 1.06 (0.90–1.26); Q3 (HDL-C 50–61 mg/dl), 1.04 (0.89–1.23); Q4, reference). However, compared with the highest quartile of LDL-C, low LDL-C was associated with higher rates of sepsis (Q1 (LDL-C 3–89 mg/dl), 1.30 (1.10–1.52); Q2 (LDL-C 90–111 mg/dl), 1.24 (1.06–1.47); Q3 (LDL-C 112–135 mg/dl), 1.07 (0.91–1.26); Q4, reference).ConclusionLow LDL-C was associated with higher long-terms rates of community-acquired sepsis. HDL-C level was not associated with long-term sepsis rates.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1579-8) contains supplementary material, which is available to authorized users.

Exploring the Predictive Ability of Dysfunctional High-Density Lipoprotein for Adverse Outcomes in Emergency Department Patients with Sepsis: A Preliminary Investigation

“…Rapid drops in both HDL and LDL cholesterol have been reported in previous studies, 5–7 and our group recently demonstrated that low LDL is a risk factor for long-term community-acquired sepsis. 8 Similarly, in this study, patients with adverse outcomes experienced more severe drops in LDL. There may be several reasons for early drops in lipid concentrations during sepsis.…”

“…7 Most recently, our group demonstrated that low LDL-C levels were predictive of long-term community acquired sepsis risk. 8 …”

Association Between Low-Density Lipoprotein Cholesterol Levels and Risk for Sepsis Among Patients Admitted to the Hospital With Infection

“…Low LDL-C levels were associated with increased risk of death in patients with community-acquired pneumonia 9 and with increased risk of sepsis in hospitalized patients 7 ; also, sepsis outcomes were worse than those of patients with high LDL-C levels. 8 , 10 However, these studies do not necessarily implicate LDL-C directly as a modifier of sepsis because the confounding effects of comorbid illness could account for the findings (ie, sicker patients could have lower LDL-C levels and worse outcomes). An epidemiologic study of approximately 30 000 community-dwelling adults was less prone to confounding and showed that lower LDL-C levels at entry to the cohort were associated with increased risk of future sepsis.…”

“…Patients with low levels of LDL cholesterol (LDL-C) have an increased risk of sepsis and worse outcomes 7 , 8 , 9 ; however, these studies do not answer the question whether LDL-C modifies the risk of sepsis and poor outcomes directly, or if it does so indirectly through the effects of comorbid illness. A study performed in community-dwelling adults 10 showed that low LDL-C levels at entry to the cohort were associated with an increased risk of future sepsis, suggesting that LDL-C levels could affect the risk of sepsis directly.…”

Lipid Profile and Differential Lipids in Serum Predict Severity of Community-Acquired Pneumonia: A Prospective, Multi-Centre Study

“…They are not only considered as the components of membranes and source, but also act as an indispensable factor in the immune response by organizing signalling complexes in cellular membrane [9]. Studies have confirmed that lipids act as important inflammatory mediators during infection process [7,[9][10].…”