Faheem W Guirgis1, Christiaan Leeuwenburgh2, Lyle Moldawer3, Gabriela Ghita4, Lauren Page Black5, Morgan Henson5, Elizabeth DeVos5, David Holden5, Phil Efron3, Srinivasa T Reddy6, Frederick A Moore3. 1. Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville 655 West 8th Street, Jacksonville, FL, 32209, USA. Faheem.Guirgis@jax.ufl.edu. 2. Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, FL, USA. 3. Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA. 4. Department of Biostatistics, University of Florida College of Public Health and Health Professions, Gainesville, USA. 5. Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville 655 West 8th Street, Jacksonville, FL, 32209, USA. 6. Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA.
Abstract
RATIONALE: Sepsis is a life-threatening, dysregulated response to infection. Lipid biomarkers including cholesterol are dynamically regulated during sepsis and predict short-term outcomes. In this study, we investigated the predictive ability of lipid biomarkers for physical function and long-term mortality after sepsis. METHODS: Prospective cohort study of sepsis patients admitted to a surgical intensive-care unit (ICU) within 24 h of sepsis bundle initiation. Samples were obtained at enrollment for lipid biomarkers. Multivariate regression models determined independent risk factors predictive of poor performance status (Zubrod score of 3/4/5) or survival at 1-year follow-up. MEASUREMENTS AND MAIN RESULTS: The study included 104 patients with surgical sepsis. Enrollment total cholesterol and high-density lipoprotein (HDL-C) levels were lower, and myeloperoxidase (MPO) levels were higher for patients with poor performance status at 1 year. A similar trend was seen in comparisons based on 1-year mortality, with HDL-C and ApoA-I levels being lower and MPO levels being higher in non-survivors. However, multivariable logistic regression only identified baseline Zubrod and initial SOFA score as significant independent predictors of poor performance status at 1 year. Multivariable Cox regression modeling for 1-year survival identified high Charlson comorbidity score, low ApoA-I levels, and longer vasopressor duration as predictors of mortality over 1-year post-sepsis. CONCLUSIONS: In this surgical sepsis study, lipoproteins were not found to predict poor performance status at 1 year. ApoA-I levels, Charlson comorbidity scores, and duration of vasopressor use predicted 1 year survival. These data implicate cholesterol and lipoproteins as contributors to the underlying pathobiology of sepsis.
RATIONALE: Sepsis is a life-threatening, dysregulated response to infection. Lipid biomarkers including cholesterol are dynamically regulated during sepsis and predict short-term outcomes. In this study, we investigated the predictive ability of lipid biomarkers for physical function and long-term mortality after sepsis. METHODS: Prospective cohort study of sepsispatients admitted to a surgical intensive-care unit (ICU) within 24 h of sepsis bundle initiation. Samples were obtained at enrollment for lipid biomarkers. Multivariate regression models determined independent risk factors predictive of poor performance status (Zubrod score of 3/4/5) or survival at 1-year follow-up. MEASUREMENTS AND MAIN RESULTS: The study included 104 patients with surgical sepsis. Enrollment total cholesterol and high-density lipoprotein (HDL-C) levels were lower, and myeloperoxidase (MPO) levels were higher for patients with poor performance status at 1 year. A similar trend was seen in comparisons based on 1-year mortality, with HDL-C and ApoA-I levels being lower and MPO levels being higher in non-survivors. However, multivariable logistic regression only identified baseline Zubrod and initial SOFA score as significant independent predictors of poor performance status at 1 year. Multivariable Cox regression modeling for 1-year survival identified high Charlson comorbidity score, low ApoA-I levels, and longer vasopressor duration as predictors of mortality over 1-year post-sepsis. CONCLUSIONS: In this surgical sepsis study, lipoproteins were not found to predict poor performance status at 1 year. ApoA-I levels, Charlson comorbidity scores, and duration of vasopressor use predicted 1 year survival. These data implicate cholesterol and lipoproteins as contributors to the underlying pathobiology of sepsis.
Authors: Faheem W Guirgis; Scott Brakenridge; Selina Sutchu; Jay D Khadpe; Taylor Robinson; Richard Westenbarger; Stephen T Topp; Colleen J Kalynych; Jennifer Reynolds; Sunita Dodani; Frederick A Moore; Alan E Jones Journal: J Trauma Acute Care Surg Date: 2016-09 Impact factor: 3.313
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Authors: Russell B Hawkins; Steven L Raymond; Julie A Stortz; Hiroyuki Horiguchi; Scott C Brakenridge; Anna Gardner; Philip A Efron; Azra Bihorac; Mark Segal; Frederick A Moore; Lyle L Moldawer Journal: Front Immunol Date: 2018-07-02 Impact factor: 7.561
Authors: Kristina E Rudd; Sarah Charlotte Johnson; Kareha M Agesa; Katya Anne Shackelford; Derrick Tsoi; Daniel Rhodes Kievlan; Danny V Colombara; Kevin S Ikuta; Niranjan Kissoon; Simon Finfer; Carolin Fleischmann-Struzek; Flavia R Machado; Konrad K Reinhart; Kathryn Rowan; Christopher W Seymour; R Scott Watson; T Eoin West; Fatima Marinho; Simon I Hay; Rafael Lozano; Alan D Lopez; Derek C Angus; Christopher J L Murray; Mohsen Naghavi Journal: Lancet Date: 2020-01-18 Impact factor: 202.731