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Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation

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Abstract

Objective

Lipoproteins modulate vascular cell function in inflammation. In this study, we analyzed whether plasma concentrations of lipoproteins and apolipoproteins in human sepsis are related to patient survival and the activation of blood monocytes and platelets.

Design

Observational study.

Setting

Medical and surgical intensive care units (ICU) of a university hospital.

Patients

151 consecutive patients after sepsis criteria had been met for the first time.

Interventions

None.

Measurements

Plasma lipoproteins, apolipoproteins, platelet CD62P-expression, monocyte HLA-DR-expression, SAPS II-scores (Simplified Acute Physiology Score) and 30-day-mortality were recorded.

Results

Total cholesterol, high-density-lipoprotein (HDL) and low-density-lipoprotein (LDL) cholesterol, apolipoprotein (apo)-AI and apo-B were all found to be significantly lower in non-survivors than in survivors. In contrast to other (apo)lipoproteins, apo-AI and HDL cholesterol further decreased in non-survivors during the ICU stay. Logistic regression analysis revealed apo-AI to be an independent predictor of 30-day-mortality. A significant inverse correlation was found for apo-AI/HDL-cholesterol and platelet activation. Later in the course of the disease, HLA-DR expression on monocytes correlated positively to apo-AI and apo-CI concentrations and inversely to the apo-E concentration.

Conclusion

Low apo-AI is independently related to 30-day mortality in human sepsis and the decrease in apo-AI/HDL cholesterol correlates to increased platelet activation. Moreover, changes in apolipoproteins supposed to modulate lipopolysaccharide effects, such as apo-CI and apo-E, correlate to monocyte activation.

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Authors and Affiliations

  1. Institute for Clinical Chemistry and Laboratory Medicine, University of Regensburg, 93042, Regensburg, Germany

    Stefan Barlage, Carsten Gnewuch, Gerhard Liebisch, Zsuzsanna Wolf, Gregor Rothe & Gerd Schmitz

  2. Department of Anesthesiology, University of Regensburg, Regensburg, Germany

    Dieter Fröhlich

  3. Department of Internal Medicine I, University of Regensburg, Regensburg, Germany

    Franz-Xaver Audebert & Thomas Glück

  4. Department of Internal Medicine II, University of Regensburg, Regensburg, Germany

    Bernhard K. Krämer

  5. Department of Internal Medicine I, University of Bochum, Herne, Germany

    Bernhard K. Krämer

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  1. Stefan Barlage
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  2. Carsten Gnewuch
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  3. Gerhard Liebisch
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  4. Zsuzsanna Wolf
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  5. Franz-Xaver Audebert
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  7. Dieter Fröhlich
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Correspondence to Gerd Schmitz.

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Barlage, S., Gnewuch, C., Liebisch, G. et al. Changes in HDL-associated apolipoproteins relate to mortality in human sepsis and correlate to monocyte and platelet activation. Intensive Care Med 35, 1877–1885 (2009). https://doi.org/10.1007/s00134-009-1609-y

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  • DOI: https://doi.org/10.1007/s00134-009-1609-y

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