Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock

Bermudes, Ana Carolina Gouvea; Carvalho, Werther Brunow de; Zamberlan, Patrícia; Muramoto, Giovana; Maranhão, Raul C.; Delgado, Artur Figueiredo

doi:10.1016/j.nut.2017.09.015

Cited by 44 publications

(43 citation statements)

References 37 publications

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“…This is a host response to several critical conditions and not necessarily an observation specific to dengue; it has also been reported in patients with sepsis, burns, and trauma . During severe sepsis/septic shock, when the inflammatory response is improved, the levels of total cholesterol, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation . In turn, derangements in metabolism with lipid redistribution and altered glucose handling are hallmarks of the pathophysiological response to burn and severe trauma …”

Section: Discussionmentioning

confidence: 80%

“…However, it is important to point out, that not only in severe dengue condition as well as in many other critical illnesses, the serum total‐cholesterol levels are significantly reduced . This is a host response to several critical conditions and not necessarily an observation specific to dengue; it has also been reported in patients with sepsis, burns, and trauma . During severe sepsis/septic shock, when the inflammatory response is improved, the levels of total cholesterol, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation .…”

Section: Discussionmentioning

confidence: 86%

“…56 During severe sepsis/septic shock, when the inflammatory response is improved, the levels of total cholesterol, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation. 55 In turn, derangements in metabolism with lipid redistribution and altered glucose handling are hallmarks of the pathophysiological response to burn and severe trauma. 56 In contrast, our meta-analysis found no statistically significant relationship between triglyceride levels and dengue severity.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Serum lipid profile as a predictor of dengue severity: A systematic review and meta‐analysis

Lima

Souza

Fernandes

et al. 2019

Reviews in Medical Virology

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Summary Dengue virus is known to modulate host cell lipid metabolism in order to promote efficient viral replication. Recent studies have focused on circulating lipids as potential biomarkers of dengue severity; however, the results obtained so far lack the consistency to establish a definite relationship between the two. Therefore, in the present study, we investigated serum lipids as potential biomarkers of dengue severity by conducting a meta‐analysis of the currently available clinical data. Nine studies that evaluated 1,953 patients were included in the review, many of which were cross‐sectional (44.4%) and conducted in Asian countries (55.5%). These studies observed the presence of lipids in serum samples (77%) of patients in the acute phase of the disease (88.8%). Circulating total‐cholesterol (P = .001) and LDL (P = .001) levels, but not HDL (P = .07), VLDL (P = .9) and triglyceride (P = .57) levels, were inversely and significantly correlated with dengue severity. Total cholesterol (P ≤ .001) and LDL (P = .001) were also useful in determining the risk of hypovolemic shock in patients with severe dengue. Subgroup analysis showed that factors, such as design (cross‐sectional vs cohort), racial‐ethnic differences (Asian vs Latin Americans), and age range (children vs adult) influenced the correlation and also contributed to the high level of heterogeneity in the studies. Our meta‐analysis demonstrates that total‐cholesterol and LDL‐cholesterol levels should be explored as routine laboratory markers for dengue severity, as they will help in employing an appropriate patient therapy, and thus optimize the use of available resources.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Serum lipid profile as a predictor of dengue severity: A systematic review and meta‐analysis

Lima

Souza

Fernandes

et al. 2019

Reviews in Medical Virology

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“…12 The outcomes are distinct for these patients and need assessment of multiple specialties. [13][14][15][16][17][18][19][20] Recently, a study evaluated a large population of children and adolescents with PCDs followed in a Latin American tertiary hospital. The authors reported that patients required many appointments in multiple medical specialties and hospital admissions, especially in early adolescence.…”

Section: Introductionmentioning

confidence: 99%

Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

Passone

Grisi

Farhat

et al. 2020

Rev. paul. pediatr.

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Objective: To assess demographic data and characteristics of children and adolescents with pediatric chronic diseases (PCD), according to the number of specialties/patient. Methods: We performed a cross-sectional study with 16,237 PCD patients at outpatient clinics in one year. Data were analyzed by an electronic data system, according to the number of physician appointments for PCD. This study assessed: demographic data, follow-up characteristics, types of medical specialty, diagnosis (International Statistical Classification of Diseases and Related Health Problems - ICD-10), number of day hospital clinic visits, and acute complications. Results: Patients followed by ≥3 specialties simultaneously showed a significantly higher duration of follow-up compared to those followed by ≤2 specialties [2.1 (0.4-16.4) vs. 1.4 (0.1-16.2) years; p<0.001] and a higher number of appointments in all specialties. The most prevalent medical areas in patients followed by ≥3 specialties were: Psychiatry (Odds Ratio - OR=8.0; confidence interval of 95% - 95%CI 6-10.7; p<0.001), Palliative/Pain Care (OR=7.4; 95%CI 5.7-9.7; p<0.001), Infectious Disease (OR=7.0; 95%CI 6.4-7.8; p<0.001) and Nutrology (OR=6.9; 95%CI 5.6-8.4; p<0.001). Logistic regressions demonstrated that PCD patients followed by ≥3 specialties were associated with high risk for: number of appointments/patient (OR=9.2; 95%CI 8.0-10.5; p<0.001), day hospital clinic visits (OR=4.8; 95%CI 3.8-5.9; p<0.001), emergency department visits (OR=3.2; 95%CI 2.9-3.5; p<0.001), hospitalizations (OR=3.0; 95%CI 2.7-3.3; p<0.001), intensive care admissions (OR=2.5; 95%CI 2.1-3.0; p<0.001), and deaths (OR=2.8; 95%CI 1.9-4.0; p<0.001). The diagnosis of asthma, obesity, chronic pain, and transplant was significantly higher in patients followed by ≥3 specialties. Conclusions: The present study showed that PCD patients who required simultaneous care from multiple medical specialties had complex and severe diseases, with specific diagnoses.

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“…Hypercholesterolemia, elevated levels of cholesterol in blood plasma, has been linked to cardiovascular and pulmonary inflammation [6] and the overloading of macrophages with cholesterol in vitro has been shown to initiate immune responses. In contrast, unduly lowering the biosynthetic production of cholesterol levels, such as more recently shown via pathogenic infections which may lead to sepsis, can have dramatic adverse results [7,8].…”

Section: Introductionmentioning

confidence: 99%

An Integrated Mathematical Model of Cellular Cholesterol Biosynthesis and Lipoprotein Metabolism

2018

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Abstract:Cholesterol regulation is an important aspect of human health. In this work we bring together and extend two recent mathematical models describing cholesterol biosynthesis and lipoprotein endocytosis to create an integrated model of lipoprotein metabolism in the context of a single hepatocyte. The integrated model includes a description of low density lipoprotein (LDL) receptor and cholesterol synthesis, delipidation of very low density lipoproteins (VLDLs) to LDLs and subsequent lipoprotein endocytosis. Model analysis shows that cholesterol biosynthesis produces the majority of intracellular cholesterol. The availability of free receptors does not greatly effect the concentration of intracellular cholesterol, but has a detrimental effect on extracellular VLDL and LDL levels. We test our model by considering its ability to reproduce the known biology of Familial Hypercholesterolaemia and statin therapy. In each case the model reproduces the known biological behaviour. Quantitative differences in response to statin therapy are discussed in the context of the need to extend the work to a more in vivo setting via the incorporation of more dietary lipoprotein related processes and the need for further testing and parameterisation of in silico models of lipoprotein metabolism.

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Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock

Cited by 44 publications

References 37 publications

Serum lipid profile as a predictor of dengue severity: A systematic review and meta‐analysis

Serum lipid profile as a predictor of dengue severity: A systematic review and meta‐analysis

Complexity of Pediatric Chronic Disease: Cross-Sectional Study With 16,237 Patients Followed by Multiple Medical Specialties

An Integrated Mathematical Model of Cellular Cholesterol Biosynthesis and Lipoprotein Metabolism

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