The Clinical Significance of Low Serum Arachidonic Acid in Sepsis Patients with Hypoalbuminemia

Abstract

Objectives Fatty acids (FAs) have various roles in pro-inflammatory and anti-inflammatory functions. Hypoalbuminemia is often observed in sepsis patients. An imbalance among these compounds formed from FAs caused by hypoalbuminemia may be related to increased mortality in sepsis patients. The purpose of this study was to investigate the correlations between serum albumin and FAs in sepsis and the outcome. Methods This study was an observational investigation. The clinical and laboratory data of sepsis patients were recorded and the Sequential Organ Failure Assessment (SOFA) score was calculated at admission. The serum arachidonic acid (AA), eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and dihomo-gamma-linolenic acid (DHLA) levels were also measured as FAs. The body mass index (BMI) was used to determine the general nutrition status. Results Two hundred sepsis patients were enrolled during the study period. No significant correlations were observed between the BMI and the SOFA score or the serum albumin level at admission. The FA levels of the non-survivors were significantly lower, but there were no significant differences in the EPA/AA levels of the survivors and non-survivors. A low serum albumin level was closely related to low AA (p<0.0001), EPA (p<0.0001), DHA (p=0.0003), and DHLA levels (p<0.0001). A multiple logistic-regression analysis revealed that a high SOFA score [adjusted odds ratio, 1.19; 95% confidence interval (CI), 1.02-1.39, p=0.026] and low AA (adjusted odds ratio, 0.98; 95% CI, 0.978-0.994, p=0.041) were associated with a poor outcome. Conclusion A lower AA level was an important determinant of the outcome of patients with sepsis. These findings are consistent with the findings of previous studies, which reported that hypoalbuminemia might alter the AA metabolism in sepsis patients.

X-Linked Immunodeficient Mice With No Functional Bruton's Tyrosine Kinase Are Protected From Sepsis-Induced Multiple Organ Failure

“…The elevated and reduced plasma levels of some restored metabolites in the WT CLP group were already shown. For example, an increased metabolism of the lipid mediators AA and EPA could be found in plasma of sepsis patients ( 61 ). In addition, two other lipid mediators, OEA and lyso-PAF, were decreased in CLP-induced WT mice.…”

Hypoalbuminemia as Surrogate and Culprit of Infections

“…The cell membrane is rich in polyunsaturated fatty acids that give rise to both pro-inflammatory and anti-inflammatory eicosanoids [ 56 ]. Hypoalbuminemia might alter the metabolism of arachidonic acid, and lower arachidonic acid level has been reported to be an important determinant of outcome in sepsis patients [ 57 ]. Albumin enhances the formation of anti-inflammatory lipoxins, resolvins and protectins that facilitate resolution of disease processes ( Figure 3 ) [ 58 ].…”

Arachidonic Acid Is a Safe and Efficacious Schistosomicide, and an Endoschistosomicide in Natural and Experimental Infections, and Cysteine Peptidase Vaccinated Hosts

“…Irreversible death of adult worms cultured in 100% FCS required 5 h incubation in the presence of 10 mM ARA, likely because of ARA binding to serum albumin, allowing only few millimolar concentrations to be stabilized in an aqueous environment (25). Propensity of ARA to bind to serum albumin explains why adult worms strive in human blood, where unesterified free ARA is in the normal range of less than 1 mM 300 microg/mL (25)(26)(27), and the difficulty of increasing serum ARA concentrations to the coveted schistosomicidal levels (21). No worm death was observed when assays were performed in the presence of nSMase specific inhibitors, suggesting SM hydrolysis is a major ARA-mediated schistosomicidal mechanism, resulting into tegument disintegration and destruction as judged by scanning and transmission electron microscopy (21).…”