Low total cholesterol and high total bilirubin are associated with prognosis in patients with prolonged sepsis

Yamano, Shuhei; Shimizu, Kentaro; Ogura, Hiroshi; Hirose, Tomoya; Hamasaki, Toshimitsu; Tasaki, Osamu

doi:10.1016/j.jcrc.2015.09.033

Cited by 49 publications

(47 citation statements)

References 23 publications

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“…Furthermore, the optimal cutoff value of serum TBIL was 64.5 μ mol/L for prognostic prediction in the pediatric patients with SALI in the present study. In another clinical trial, the cutoff value of serum TBIL was 1.35 mg/dL for prognosis of the adult patients with prolonged sepsis [ 23 ]. The difference of the cutoff value for serum TBIL possibly relies on age and disease, which need further investigation through well-designed clinical trials.…”

Section: Discussionmentioning

confidence: 99%

Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Cui

Shan

Chen

et al. 2018

Canadian Journal of Infectious Diseases and Medical Microbiolog

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Aims The aim of this study was to assess the prognostic value of the serum total bilirubin (TBIL) level in pediatric patients with sepsis-associated liver injury (SALI). Methods We performed a retrospective study of patients with SALI admitted to the pediatric intensive care unit (PICU) in Shanghai Children's Hospital between December 2012 and December 2015. Serum TBIL concentration was determined within 72 h after PICU admission. Results Seventy-two patients with SALI were included in this study. The overall mortality rate was 36.1% (26/72). The serum levels of TBIL of patients were significantly higher in the nonsurvivor group than the survivor group. Cox regression analysis indicated that the elevated serum TBIL level within 72 hours after admission was an independent risk factor of mortality in patients with SALI. Furthermore, the area under the receiver-operating characteristic (ROC) curve (AUC) for TBIL was 0.736 (95% confidence interval (CI): 0.614–0.858, P=0.001), in which the optimal cut-off value was 64.5 μmol/L. The combined index named “TBIL” and “TBA” showed an AUC of 0.745 (0.626–0.865) for predicting the prognosis in patients with SALI. In addition, the Kaplan–Meier curve indicated that the 28-day survival rate was significantly lower in patients with higher serum TBIL levels (≥64.5 μmol/L) or higher value of TBIL and TBA (≥−0.8902). Conclusions Elevated serum TBIL level is associated with poor outcomes in pediatric SALI.

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Section: Discussionmentioning

confidence: 99%

Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Cui

Shan

Chen

et al. 2018

Canadian Journal of Infectious Diseases and Medical Microbiolog

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“…Some studies concluded that glucose metabolism profoundly affects RBP4 levels 6, 21, 22 ; however, others have noted a link between lipid metabolism and RBP4 levels 23–29 . Rat studies demonstrated that acute stress had a direct influence on liver lipid metabolism 30 , and human studies demonstrated that low TC levels are associated with a poor prognosis in patients with prolonged sepsis 31 . Moreover, both HDL-C and low-density lipoprotein (LDL-C) levels decreased because of lecithin cholesterol acyltransferase impairment in critical illness 32 .…”

Section: Discussionmentioning

confidence: 99%

Retinol-binding protein-4 expression marks the short-term mortality of critically ill patients with underlying liver disease: Lipid, but not glucose, matters

Chen

Lee

Chang

et al. 2017

Sci Rep

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The implications of retinol-binding protein-4 (RBP4) expression in critically ill patients with underlying liver diseases remain unclear. A prospective cohort study involving 200 liver intensive care unit (ICU) patients was conducted, with 274 blood donors as controls. Patient outcomes were assessed using Cox and Kaplan-Meier analyses. Of the 200 ICU patients (mean age: 56.0 yrs), 79.5% were male, 72.5% were cirrhotic, 62% were septic, 29.5% were diabetic, and 29% expired in the ICU (median admission: 7.5 days). ICU patients had lower baseline RBP4 (25.6+/−18.4 vs. 43.8+/−35.0 mg/L, p < 0.001) and total cholesterol (TC) levels than controls. The surviving ICU patients had lower baseline international normalized ratios (INRs) of prothrombin time, model for end-stage liver disease (MELD) scores and sepsis rates, but higher estimated glomerular filtration rates (eGFRs) and RBP4 levels than non-surviving patients. eGFRs, INRs and TC levels were independently associated with RBP4 levels. Only surviving patients exhibited significantly increased RBP4 levels after ICU discharge. Baseline RBP4 levels and MELD scores predicted 21-day (≤10 mg/L) and 1-year (≥25) mortality, respectively. In critically ill patients with underlying liver disease, with a link to eGFRs, INRs and TC levels, the baseline RBP4 may serve as a marker for short-term mortality.

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“…Observational studies revealed association of low LDL‐C with increased mortality in the general population and specifically in elderly humans as well as in patients with acute myocardial infarction or community‐acquired pneumonia . A low cholesterol concentration in sepsis patients has been suggested as a marker for a bad prognosis .…”

Section: Ldl‐c Infections and The Immune Systemmentioning

confidence: 99%

Can LDL cholesterol be too low? Possible risks of extremely low levels

et al. 2017

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Low total cholesterol and high total bilirubin are associated with prognosis in patients with prolonged sepsis

Cited by 49 publications

References 23 publications

Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Elevated Serum Total Bilirubin Level Is Associated with Poor Outcomes in Pediatric Patients with Sepsis-Associated Liver Injury

Retinol-binding protein-4 expression marks the short-term mortality of critically ill patients with underlying liver disease: Lipid, but not glucose, matters

Can LDL cholesterol be too low? Possible risks of extremely low levels

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