Michael D Maile1, Matthew J Sigakis2, Kathleen A Stringer3, Elizabeth S Jewell2, Milo C Engoren2. 1. Department of Anesthesiology, Division of Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, USA. Electronic address: mmaile@med.umich.edu. 2. Department of Anesthesiology, Division of Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. 3. Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, USA; Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA.
Abstract
PURPOSE: To determine if baseline lipid levels contribute to the relationship between lipid levels during sepsis and outcomes. MATERIALS AND METHODS: We conducted a retrospective cohort study at a tertiary-care academic medical center. Multivariable logistic regression models were used to adjust for confounders. Both Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) score-based definitions of sepsis were analyzed. MEASUREMENTS AND MAIN RESULTS: After adjusting for patient characteristics and severity of illness, baseline values for both low density lipoprotein (LDL) cholesterol and triglycerides were associated with mortality (LDL cholesterol odds ratio [OR] 0.44, 95% confidence interval [CI] 0.23-0.84, p = .013; triglyceride OR 0.54, 95% CI 0.37-0.78, p = .001) using a SIRS based definition of sepsis. An interaction existed between these two variables, which resulted in increased mortality with higher baseline low density lipoprotein (LDL) cholesterol values for individuals with triglycerides below 208 mg/dL and the opposite direction of association above this level (interaction OR 1.48, 95% CI 1.02-2.16, p = .039). When using a SOFA score-based definition, only triglycerides remained associated with the mortality (OR 0.55, 95% CI 0.35-0.86, p = .008). CONCLUSIONS: Baseline lipid values, particularly triglyceride concentrations, are associated with hospital mortality in septic patients.
PURPOSE: To determine if baseline lipid levels contribute to the relationship between lipid levels during sepsis and outcomes. MATERIALS AND METHODS: We conducted a retrospective cohort study at a tertiary-care academic medical center. Multivariable logistic regression models were used to adjust for confounders. Both Systemic Inflammatory Response Syndrome (SIRS) and Sequential Organ Failure Assessment (SOFA) score-based definitions of sepsis were analyzed. MEASUREMENTS AND MAIN RESULTS: After adjusting for patient characteristics and severity of illness, baseline values for both low density lipoprotein (LDL) cholesterol and triglycerides were associated with mortality (LDL cholesterol odds ratio [OR] 0.44, 95% confidence interval [CI] 0.23-0.84, p = .013; triglyceride OR 0.54, 95% CI 0.37-0.78, p = .001) using a SIRS based definition of sepsis. An interaction existed between these two variables, which resulted in increased mortality with higher baseline low density lipoprotein (LDL) cholesterol values for individuals with triglycerides below 208 mg/dL and the opposite direction of association above this level (interaction OR 1.48, 95% CI 1.02-2.16, p = .039). When using a SOFA score-based definition, only triglycerides remained associated with the mortality (OR 0.55, 95% CI 0.35-0.86, p = .008). CONCLUSIONS: Baseline lipid values, particularly triglyceride concentrations, are associated with hospital mortality in septic patients.
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