Persistence of Lipoproteins and Cholesterol Alterations after Sepsis: Implication for Atherosclerosis Progression

Abstract

(1) Background: Sepsis is one of the most common critical care illnesses with increasing survivorship. The quality of life in sepsis survivors is adversely affected by several co-morbidities, including increased incidence of dementia, stroke, cardiac disease and at least temporary deterioration in cognitive dysfunction. One of the potential explanations for their progression is the persistence of lipid profile abnormalities induced during acute sepsis into recovery, resulting in acceleration of atherosclerosis. (2) Methods: This is a targeted review of the abnormalities in the long-term lipid profile abnormalities after sepsis; (3) Results: There is a well-established body of evidence demonstrating acute alteration in lipid profile (HDL-c ↓↓, LDL-C -c ↓↓). In contrast, a limited number of studies demonstrated depression of HDL-c levels with a concomitant increase in LDL-C -c in the wake of sepsis. VLDL-C -c and Lp(a) remained unaltered in few studies as well. Apolipoprotein A1 was altered in survivors suggesting abnormalities in lipoprotein metabolism concomitant to overall lipoprotein abnormalities. However, most of the studies were limited to a four-month follow-up and patient groups were relatively small. Only one study looked at the atherosclerosis progression in sepsis survivors using clinical correlates, demonstrating an acceleration of plaque formation in the aorta, and a large metanalysis suggested an increase in the risk of stroke or acute coronary event between 3% to 9% in sepsis survivors. (4) Conclusions: The limited evidence suggests an emergence and persistence of the proatherogenic lipid profile in sepsis survivors that potentially contributes, along with other factors, to the clinical sequel of atherosclerosis.

Prognostic value of lipid profile in adult hemophagocytic lymphohistiocytosis

“…Univariate and multivariate analyses demonstrated that HDL-c was an independent prognostic factor for survival. These results are consistent with prior findings that the level of cholesterol and lipoproteins is one of the hallmarks of survival and demise in critical illness and inflammatory disorders ( 6 , 24 – 26 ). Tanaka et al.…”

“…Previous studies have suggested that serum lipid levels can indirectly measure pro-inflammatory cytokine bioactivity, even without obesity, diabetes, and metabolic syndrome ( 5 ). Additionally, components of cholesterol metabolism are essential in response to infection by moderating the immunological response during acute septic episodes ( 6 ). Moreover, the serum cholesterol levels may reflect a metabolic response of the organism to the inflammatory condition in septic patients, independent of diet or treatment ( 7 ).…”

Potential Biomarkers for Post-Stroke Cognitive Impairment: A Systematic Review and Meta-Analysis

“…It is also the precursor of all steroid hormones and bile acids and plays a key role in membrane trafficking, transmembrane signaling processes, and cell proliferation [ 42 , 43 , 44 , 45 , 46 ]. Cholesterol is typically transported as lipoproteins, which consist of TG and cholesterol in the center surrounded by a phospholipid shell with apolipoprotein embedded in them [ 47 , 48 ]. The relationship between lipids and cognition is controversial.…”

Patients with Bacterial Sepsis Are Heterogeneous with Regard to Their Systemic Lipidomic Profiles

“…Several previous studies have investigated serum levels of lipoproteins and lipid classes in patients with sepsis; these results have been discussed in several recent reviews [ 98 , 99 , 100 , 101 , 102 ]. First, sepsis patients show decreased levels of High (HDL) and Low density (LDL) lipoproteins, and these levels are inversely correlated with the levels of pro-inflammatory cytokines.…”