Genetic association of lipids and lipid-lowering drugs with sepsis: a Mendelian randomization and mediation analysis

Abstract

BackgroundThe impact of lipid-lowering medications on sepsis is still not well defined. A Mendelian randomization (MR) study was carried out to probe the causal connections between genetically determined lipids, lipid-reducing drugs, and the risk of sepsis.Materials and methodsData on total serum cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A-I (ApoA-I), apolipoprotein B (ApoB), and triglycerides (TG) were retrieved from the MR-Base platform and the Global Lipids Genetics Consortium in 2021 (GLGC2021). Our study categorized sepsis into two groups: total sepsis and 28-day mortality of sepsis patients (sepsis28). The inverse-variance weighted (IVW) method was the primary method used in MR analysis. Cochran's Q test and the MR-Egger intercept method were used to assess the heterogeneity and pleiotropy.ResultsIn the MR analysis, we found that ApoA-I played a suggestively positive role in protecting against both total sepsis (OR, 0.863 per SD increase in ApoA-I; 95% CI, 0.780–0.955; P = 0.004) and sepsis28 (OR, 0.759; 95% CI, 0.598–0.963; P = 0.023). HDL-C levels were also found to suggestively reduce the incidence of total sepsis (OR, 0.891 per SD increase in HDL-C; 95% CI, 0.802–0.990; P = 0.031). Reverse-MR showed that sepsis28 led to a decrease in HDL-C level and an increase in TG level. In drug-target MR, we found that HMGCR inhibitors positively protected against total sepsis (1OR, 0.719 per SD reduction in LDL-C; 95% CI, 0.540–0.958; P = 0.024). LDL-C and HDL-C proxied CETP inhibitors were found to have a protective effect on total sepsis, with only LDL-C proxied CETP inhibitors showing a suggestively protective effect on sepsis28. In Mediated-MR, BMI exhibited a negative indirect effect in HMGCR inhibitors curing sepsis. The indirect impact of ApoA-I explained over 50% of the curative effects of CETP inhibitors in sepsis.ConclusionsOur MR study suggested that ApoA-I and HDL-C protected against sepsis, while HMGCR and CETP inhibitors showed therapeutic potential beyond lipid-lowering effects. ApoA-I explained the effects of CETP inhibitors. Our study illuminates how lipids affect sepsis patients and the effectiveness of new drugs, opening new avenues for sepsis treatment.

Associations of educational attainment with Sepsis mediated by metabolism traits and smoking: a Mendelian randomization study

“…This association could be partially explained by differences in eating patterns ( 28 ). Previous Mendelian research ( 27 , 29 ) have shown that increased amounts of omega-3 and ApoA-I have the potential to reduce the risk of sepsis. The exact mechanisms are still unknown but could potentially include changes in the gut microbiome and increased production of substances that reduce inflammation ( 30–32 ).…”

“…Intriguingly, obesity-related traits (BMI) and smoking, individually, mediated more than 35% of the overall mediation effects. Previously conducted observational studies ( 25 , 26 ) and Mendelian research ( 12 , 13 , 27 ) have established a close association between obesity, smoking, and sepsis. Moreover, the HUNT investigation has revealed that the combined influence of smoking and alcohol intake contributes to 57% of the sepsis vulnerability linked to lower educational attainment ( 9 ).…”