Serum lipid profile, cytokine production, and clinical outcome in patients with severe sepsis

Purpose: The purpose of the study is to evaluate the prevalence and clinical significance of hypolipidemia and the relationship to cytokine concentrations and outcomes in septic patients. Materials and methods: A prospective study was undertaken including 50 patients with severe sepsis due to community-acquired infections. Serum concentrations of total cholesterol, triglyceride, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein as well as tumor necrosis factor alpha (TNF-alpha), interleukin (IL) 6, IL-8, IL-10, and transforming growth factor (TGF) beta(1) were determined on admission and days 3 and 10 during hospitalization. Results: Of the 50 patients enrolled, 28 survived, whereas 22 died during their hospital stay. Sepsis survivors had significantly higher HDL-C concentrations than nonsurvivors, whereas all patients with HDL-C values greater than 25 mg/dL survived. Baseline levels of TGF-beta(1) were significantly higher in survivors. High-density lipoprotein levels correlated inversely with TNF-alpha, IL-6, and IL-10 concentrations and positively with baseline TGF-beta(1) levels. Independent risk factors of mortality were IL-10 levels on day 3, whereas HDL-C concentration on admission was related to survival. Conclusions: Low cholesterol and lipoprotein concentrations are detected in septic patients, especially in individuals with poor outcome. High-density lipoprotein cholesterol concentration seems to be an early independent predictive marker of survival in severe sepsis. (C) 2014 Elsevier Inc. All rights reserved.