Quantitative and Qualitative Assessments of Cholesterol Association With Bacterial Infection Type in Sepsis and Septic Shock

Overview

Journal J Intensive Care Med

Publisher Sage Publications

Specialty Critical Care

Date 2020 Jun 25

PMID 32578468

Citations 5

Authors

Lauren Page Black

Michael A Puskarich

Morgan Henson

Taylor Miller

Srinivasa T Reddy

Rosemarie Fernandez

Faheem W Guirgis

Affiliations

Soon will be listed here.

Abstract

Background: Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance.

Methods: This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative. We investigated quantitative (levels) and qualitative (dysfunctional high-density lipoprotein [HDL]) cholesterol differences. We used multivariable logistic regression to control for disease severity.

Results: Among 171 patients with sepsis, infections were gram negative in 67, gram positive in 46, and culture negative in 47. Both gram-negative and gram-positive infections occurred in 11 patients. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels were lower for culture-positive sepsis at enrollment (TC, < .001; LDL-C, < .001; HDL-C, = .011) and persisted after controlling for disease severity. Similarly, cholesterol levels were lower among culture-positive patients at 48 hours (TC, = .012; LDL-C, = .029; HDL-C, = .002). Triglyceride (TG) levels were lower at enrollment ( =.033) but not at 48 hours ( = .212). There were no differences in dysfunctional HDL. Among bacteremic patients, cholesterol levels were lower at enrollment (TC, = .010; LDL-C, = .010; HDL-C, ≤ .001; TG, = .005) and at 48 hours (LDL-C, = .027; HDL-C, < .001; TG, = .020), except for 48 hour TC ( = .051). In the bacteremia subgroup, enrollment TC and LDL-C were lower for gram-negative versus gram-positive infections (TC, = .039; LDL-C, = .023).

Conclusion: Cholesterol levels are significantly lower among patients with culture-positive sepsis and bacteremia.

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