Clinical Assessment and Outcome
Decreased serum level of lipoprotein cholesterol is a poor prognostic factor for patients with severe community-acquired pneumonia that required intensive care unit admission

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Abstract

Purpose

The purpose of this study is to investigate the prognostic values of the serum levels of lipids in patients with severe community-acquired pneumonia (CAP) that required intensive care unit (ICU) admission.

Materials and methods

Patients who had severe CAP that required ICU admission were included. Serum lipid level was collected on the days 1 and 7 of ICU stay. Clinical outcome, including length of ICU stay, hospital stay, and death, were monitored prospectively.

Results

A total of 40 patients were enrolled in this study. Lower high-density lipoprotein (HDL) and low-density lipoprotein (LDL) were found in nonsurvival group on ICU admission day 7 (survivors vs nonsurvivors; mean HDL, 41.8 vs 13.0 mg/dL, P = .002; LDL, 62.3 vs 30.3 mg/dL, P = 0.006, respectively). High-density lipoprotein cholesterol level of less than or equal to 17 mg/dL on day 7 (odds ratio, 1.23) and LDL cholesterol level of less than or equal to 21 mg/dL on day 7 (odds ratio, 1.10) could be a predictor of hospital mortality. The mean change in levels of HDL cholesterol in nonsurvivors decreased significantly than those in survivors from days 1 to 7 (8.5 vs − 17.4 mg/dL, P = .04) but not LDL cholesterol.

Conclusions

Decreased serum HDL cholesterol level from days 1 to 7 may be of prognostic value.

Introduction

Severe community-acquired pneumonia (CAP) is now recognized as an entity of its own requiring a specific management approach [1], [2], [3], [4], [5], [6], [7], [8]. Approximately 10% of all hospitalized patients with CAP required admission to the intensive care unit (ICU) [9], and the mortality of these patients reaches 20% to 50% [1], [2], [3], [4], [5], [6], [7]. The epidemiology, etiology, and prognosis of severe CAP have repeatedly been investigated in the last decade [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], with the increasing data about the risk factors in the studies worldwide.

There is a growing body of evidence linking lipid metabolism to the host innate immune response to infection and acute injury. Significant changes in the distribution of circulating lipoproteins in septic patients had been reported [12], [13]. High-density lipoprotein (HDL) and other lipoproteins may contribute to host homeostasis in ways other than the transport of fatty acids and cholesterol. Therefore, circulating lipids might support the body's defense against infection by binding and neutralizing bacterial toxins [14], [15], [16], [17], [18]. Chien et al [19] present additional data in support of a protective role for HDL during life-threatening infections. Decreased serum HDL cholesterol and apolipoprotein A-I levels were associated with an increased mortality rate among severely septic patients [19]. However, the correlation of serum cholesterol and outcome of severe CAP has not been well investigated.

Although the reduction in lipid and lipoprotein levels is well known in critically ill patients [20], [21], their prognostic implications in patients with severe CAP remain unclear. The aim of this study was to investigate the association between lipid kinetics and clinical outcome in patients with severe CAP. We hypothesize that there is a negative correlation between serum HDL concentrations and clinical outcome [20]. Hypocholesterolemia could be an independent predictor of mortality for severe CAP patients.

Section snippets

Patients

From November 2006 to January 2009, patients who were older than 18 years and admitted to medical ICU in National Taiwan University Hospital due to severe CAP were evaluated. Patients with permit sheet were enrolled in this study. The diagnosis of CAP was established, if chest radiographs presented with new infiltration combined with 2 of the following criteria: (1) fever with body temperature greater than 38°C, (2) leukocytosis with white blood cell greater than 11 000/mm3 or neutropenia with

Patient characteristics

From November 2006 to January 2009, 40 patients with severe CAP were enrolled in the study. There were 10 patients who died in ICU and 5 patients who died in hospital. The overall mortality rate was 37.5%. The baseline characteristics of the patients were presented as Table 1. There were 67.5% male patients (n = 27), and the mean age was 75.0 ± 14 years old. The body mass index (BMI) was relative low, especially in the nonsurvival group. More hypertensive patients and chronic obstructive

Discussions

This study investigated changes in plasma lipid levels in patients with severe CAP who required ICU admission. We found that markedly lower levels of LDL and HDL cholesterol on day 7 after ICU admission indicated poor prognosis. Decreased serum HDL cholesterol from days 1 to 7 predicted poor outcome in patients with severe CAP.

High-density lipoprotein cholesterol serves a unique function in normal lung physiology [26], [27], [28]. Recent studies have revealed important roles for cholesterol

Conclusions

Low levels of plasma lipids, particularly low HDL and LDL cholesterol on day 7, was predictive of adverse outcomes in patients with severe CAP who needed ICU admission. In addition, decreased change of serum HDL cholesterol can be a negative indicator of survival. Plasma lipid levels may be a helpful tool in the diagnostic and prognostic workup of patients with respiratory tract infections.

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