Lipid metabolism in critical illness

Green, Pnina; Theilla, Miriam; Singer, Pierre

doi:10.1097/mco.0000000000000253

Cited by 59 publications

(61 citation statements)

References 26 publications

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“…Many studies report a high incidence of hypophosphatemia . It occurs in 12%–85% of children receiving CRRT as a result of hyperexcretion in effluent and intracellular shifting .…”

Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

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“…Many studies report a high incidence of hypophosphatemia . It occurs in 12%–85% of children receiving CRRT as a result of hyperexcretion in effluent and intracellular shifting .…”

Section: Resultsmentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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“…Rat studies demonstrated that acute stress had a direct influence on liver lipid metabolism 30 , and human studies demonstrated that low TC levels are associated with a poor prognosis in patients with prolonged sepsis 31 . Moreover, both HDL-C and low-density lipoprotein (LDL-C) levels decreased because of lecithin cholesterol acyltransferase impairment in critical illness 32 . Consistent with these findings, in liver ICU patients, we also showed that HDL-C levels were lower in non-surviving patients than in surviving patients.…”

Section: Discussionmentioning

confidence: 99%

“…Given that both liver function and RBP4 are closely linked to lipid metabolism 20, 23–29 and that RBP4 is an acute response protein 6 , we would like to stress that TC levels, but not glucose levels (or glucose metabolism), were independently associated with RBP4 levels in liver ICU patients. Thus, in addition to restoring liver and renal function, supplementing patient diets with adequate TC or related precursors 32 may up-regulate RBP4-associated pathways and improve the immediate outcomes of critically ill patients with underlying liver disease.…”

Section: Discussionmentioning

confidence: 99%

Retinol-binding protein-4 expression marks the short-term mortality of critically ill patients with underlying liver disease: Lipid, but not glucose, matters

Chen

Lee

Chang

et al. 2017

Sci Rep

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The implications of retinol-binding protein-4 (RBP4) expression in critically ill patients with underlying liver diseases remain unclear. A prospective cohort study involving 200 liver intensive care unit (ICU) patients was conducted, with 274 blood donors as controls. Patient outcomes were assessed using Cox and Kaplan-Meier analyses. Of the 200 ICU patients (mean age: 56.0 yrs), 79.5% were male, 72.5% were cirrhotic, 62% were septic, 29.5% were diabetic, and 29% expired in the ICU (median admission: 7.5 days). ICU patients had lower baseline RBP4 (25.6+/−18.4 vs. 43.8+/−35.0 mg/L, p < 0.001) and total cholesterol (TC) levels than controls. The surviving ICU patients had lower baseline international normalized ratios (INRs) of prothrombin time, model for end-stage liver disease (MELD) scores and sepsis rates, but higher estimated glomerular filtration rates (eGFRs) and RBP4 levels than non-surviving patients. eGFRs, INRs and TC levels were independently associated with RBP4 levels. Only surviving patients exhibited significantly increased RBP4 levels after ICU discharge. Baseline RBP4 levels and MELD scores predicted 21-day (≤10 mg/L) and 1-year (≥25) mortality, respectively. In critically ill patients with underlying liver disease, with a link to eGFRs, INRs and TC levels, the baseline RBP4 may serve as a marker for short-term mortality.

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“…Distinct changes in lipid metabolism have been noted in the critically ill, and the associations between nutritional intervention, lipid profile, and survival are of considerable interest [7]. Nutritional supplementation with omega-3 fatty acids has been proposed to modulate the immune response in critical illness by inhibiting pro-inflammatory (eicosanoid, NF-kB) and promoting anti-inflammatory (resolvin, protectin) mediators [8–11].…”

Section: Introductionmentioning

confidence: 99%

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

Sharma

McIntyre

et al. 2017

Ann. Intensive Care

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BackgroundNutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. If proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. However, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear.MethodsWe searched the Cochrane Library, MEDLINE, and EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the Grading of Recommendations Assessment, Development and Evaluation approach to assess the quality of the evidence for each outcome.ResultsA total of 17 RCTs enrolling 1239 patients met our inclusion criteria. Omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (MD −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results.ConclusionOmega-3 nutritional supplementation may reduce ICU length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0282-5) contains supplementary material, which is available to authorized users.

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Lipid metabolism in critical illness

Cited by 59 publications

References 26 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Retinol-binding protein-4 expression marks the short-term mortality of critically ill patients with underlying liver disease: Lipid, but not glucose, matters

Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trials

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