Low apolipoprotein A-I level at intensive care unit admission and systemic inflammatory response syndrome exacerbation

Objective. Examine whether a low serum level of apolipoprotein A-I at intensive care unit (ICU) admission is associated with a further increase of the number of systemic inflammatory response syndrome (SIRS) criteria. Design. Prospective observational study. Setting. A 20-bed, university-affiliated, surgical ICU. Patients. Patients admitted after major surgery, multiple trauma, or acute pancreatitis without septic shock. Interventions. We defined as the SIRS Exacerb group patients who presented a further increase of the number of SIRS criteria during their ICU stay or, in the presence of four SIRS criteria at ICU admission, those who presented a further aggravation of organ failure. Other patients were attributed to the SIRS No Exacerb group. From day 1 to 6, we measured apolipoprotein A-I, high-density lipoprotein and total cholesterol, triglycerides, C-reactive protein, procalcitonin, serum amyloid A, interleukin 6, interleukin-1 receptor antagonist, albumin, and other nutrition-linked variables. We looked at laboratory values or factors present at ICU admission according to the two groups. Measurements and Main Results: From 63 patients analyzed, 29 (46%) were assigned to the SIRS Exacerb group. Age, sex, and SAPS II and SIRS scores at ICU admission did not differ between the groups. Patients in the SIRS Exacerb group presented more often a septic event (5/29 vs. 0/34, p = .02), had a higher hospital mortality (6/29 vs. 0/34, p = .007), and had a longer ICU stay (P =.0023). At admission, inflammatory variables such as the C-reactive protein, serum amyloid A, interieukin 6, interleukin-1 receptor antagonist plasma levels, and other lipid or nutritionlinked variables were similar between the two groups. Apolipoprotein A-I levels were lower in the SIRS Exacerb group (median [interquartile range]: 68 [56-81] vs. 84 [69-94] mg/dL, p.028). Conclusion. A low serum level of apolipoprotein A-1 at ICU admission is associated with an increase of the number of SIRS criteria during the ICU stay.