Decreased high density lipoprotein cholesterol is an independent predictor for persistent organ failure, pancreatic necrosis and mortality in acute pancreatitis

Abstract

High density lipoprotein cholesterol (HDL-C) has been reported as a significant indicator of systemic inflammation. The association underlying HDL-C and persistent organ failure (POF), pancreatic necrosis (PNec) and mortality in acute pancreatitis (AP) has not been evaluated. From 2007 to 2016, consecutive AP patients with admission lipid profiles assessment were included in this study. The association of HDL-C value and other lipids with outcomes was explored with Cox proportional regression models, which were adjusted for confounding factors. 1131 consecutive AP patients were clinically eligible. Overall, 17.9% of the patients developed with POF, 27.1% experienced PNec, and 6.7% died during hospitalization. Lower HDL-C median (<1.06 mmol/L) was identified as an independent prognostic factor of the outcomes. Moreover, there was a positive trend for the association across increasing HDL-C quartiles and POF, PNec and mortality after multivariable analysis (p values were <0.001, <0.001 and 0.043, respectively). The AUC of HDL-C for the outcomes were comparable to that of Ranson score for diagnosing POF (0.778 vs. 0.678; P < 0.001), PNec (0.734 vs. 0.701; P = 0.143) and mortality (0.768 vs. 0.745; P = 0.516). Decreased HDL-C value is an independent risk factor for the incidence of POF, PNec and in-hospital mortality in AP.

The adverse alterations of HDL in quality promote septic ARDS via exacerbated pulmonary endothelial dysfunction

“…Our findings are consistent with the previous studies that patients with sepsis showed a lower level of HDL than patients with trauma in ICU. These studies also indicated that the decreased level of HDL-C was an independent predictor for persistent organ failure and mortality in acute pancreatitis [26][27][28].…”

“…Upon septic stresses, HDL processes the anti-inflammatory function through both neutralizing lipopolysaccharide (LPS) and alleviating ECs inflammatory responses [9]. Septic patients exhibit a marked reduction in plasma HDL level and the low level of HDL cholesterol is a poor prognostic factor for severe sepsis [10][11][12]. In addition, an adverse transition of HDL to pro-inflammation was observed during acute inflammatory disorder diseases including sepsis [13][14][15].…”

Serum paraoxonase (a high-density lipoprotein-associated lipophilic antioxidant) activity in clinical follow-up of patients with acute pancreatitis, with particular emphasis on oxidative stress parameters and lipid profile: a prospective pilot trial

“…AP is an inflammatory disease, with episodes ranging in severity from mild and self-limiting to severe fulminant clinic with extensive necrosis, systemic inflammation and multiorgan failure [7]. Despite the great advances in critical care medicine, the mortality rate of acute pancreatitis has remained at about 10-20% [20].…”

“…When CTSI scores were evaluated, it was seen that majority of our patients had mild AP (0-3 points, n = 18, 72%), followed by moderate (4-6 points, n = 6, 24%) and severe (7-10 points, n = 1, 4%). Average length of hospital stay was 6 days (range, [3][4][5][6][7][8][9][10][11][12][13][14] and there was no mortality.…”

“…AP is characterized by local and systemic inflammation, which is observed clinically from no systemic sign through the local and systemic inflammatory response, organ failure, pancreatic necrosis and even death [7]. The underlying pathophysiology through which local pancreatic injury drives the systemic inflammatory response has not been fully elucidated.…”