The Incidence of Propofol-Induced Hypertriglyceridemia and Identification of Associated Risk Factors

Corrado, Michael; Kovacevic, Mary P; Dube, Kevin; Lupi, Kenneth; Szumita, Paul M.; DeGrado, Jeremy

doi:10.1097/cce.0000000000000282

Cited by 20 publications

(41 citation statements)

References 22 publications

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“…A recent study at the same institution found that 27.9% of patients developed triglyceride concentrations ≥400 mg/dL while on propofol, with a 1.5% incidence of acute pancreatitis. 10 In this study, patients developed hypertriglyceridemia after a median of 47 hours (IQR, 16.3-73.5 hours) and received a median cumulative propofol dose of 21 800 mg (IQR, 9300-32 400 mg). This contrasts with our study because patients developed hypertriglyceridemia after a median of 3.8 days and received a median cumulative propofol dose of 11 700 mg in our cohort.…”

Section: Discussionmentioning

confidence: 91%

“…Our study supports previously published evidence that propofol-associated acute pancreatitis is rare. [8][9][10] However, in response to hypertriglyceridemia, providers in our study often lowered the dose or discontinued propofol altogether and added or transitioned to an alternative sedative, often a benzodiazepine, to facilitate propofol weaning. Guidelines recommend minimizing benzodiazepines to improve shortterm outcomes such as risk of delirium and shorten the duration of mechanical ventilation and ICU length of stay.…”

Section: Discussionmentioning

confidence: 97%

“…Second, a triglyceride threshold of 400 to 500 mg/dL to discontinue propofol may be liberalized given the low risk of acute pancreatitis seen in this cohort as well as other published studies. 9 , 10 Third, consider obtaining CK concentrations every 2 to 3 days to monitor for PRIS, especially for prolonged, high-dose propofol infusions.…”

Section: Discussionmentioning

confidence: 99%

“… 5 Possible adverse effects of propofol administration include respiratory depression, hypotension, hypertriglyceridemia, and propofol-related infusion syndrome (PRIS). Hypertriglyceridemia, in turn, can be associated with acute pancreatitis, 9 , 10 which can be severe. The risk of acute pancreatitis is increased with triglyceride concentrations >500 mg/dL, and the risk is significantly higher with triglyceride concentrations >1000 mg/dL.…”

Section: Introductionmentioning

confidence: 99%

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The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

et al. 2021

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Background: Propofol is commonly used to achieve ventilator synchrony in critically ill patients with coronavirus disease 2019 (COVID-19), yet its safety in this patient population is unknown. Objective: To evaluate the safety, in particular the incidence of hypertriglyceridemia, of continuous infusion propofol in patients with COVID-19. Methods: This was a retrospective study at 1 academic medical center and 1 affiliated teaching hospital in New York City. Adult, critically ill patients with COVID-19 who received continuous infusion propofol were included. Patients who received propofol for <12 hours, were transferred from an outside hospital while on mechanical ventilation, or did not have a triglyceride concentration obtained during the infusion were excluded. Results: A total of 252 patients were included. Hypertriglyceridemia (serum triglyceride concentration ≥ 400 mg/dL) occurred in 38.9% of patients after a median cumulative dose of 4307 mg (interquartile range [IQR], 2448-9431 mg). The median time to triglyceride elevation was 3.8 days (IQR, 1.9-9.1 days). In the multivariable regression analysis, obese patients had a significantly greater odds of hypertriglyceridemia (odds ratio = 1.87; 95% CI = 1.10, 3.21). There was no occurrence of acute pancreatitis. The incidence of possible propofol-related infusion syndrome was 3.2%. Conclusion and Relevance: Hypertriglyceridemia occurred frequently in patients with COVID-19 who received propofol but did not lead to acute pancreatitis. Elevated triglyceride concentrations occurred more often and at lower cumulative doses than previously reported in patients without COVID-19. Application of these data may aid in optimal monitoring for serious adverse effects of propofol in patients with COVID-19.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

et al. 2021

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“…Interestingly, unlike HDL-C and LDL-C concentrations, the level of TG remained approximately the same over time in our study. A possible explanation is that the prolonged systematic use of propofol, which thus increases the plasma triglyceride concentrations 34 , may be counterbalanced by the systematic use of unfractionated heparin. Indeed, unfractionated heparin leads to an increased synthesis of lipoprotein lipase, which increases the hydrolysis of TG from plasma lipoproteins such as very low density lipoproteins or chylomicrons 35 .…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein concentration in patients requiring extracorporeal membrane oxygenation

Tanaka

Tymowski

Zappella

et al. 2021

Sci Rep

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Extracorporeal membrane oxygenation (ECMO), a relevant technology for patients with acute respiratory distress syndrome (ARDS) or acute cardiac failure (ACF), is a frequent cause of systemic inflammatory response syndrome. During sepsis, HDL cholesterol (HDL-C) and LDL cholesterol (LDL-C) concentrations decrease, and an association between low lipoprotein levels and poor outcomes was reported. There are no data from patients undergoing ECMO. The goal of this study was to characterize the lipoprotein profiles of ICU patients requiring ECMO. All consecutive patients admitted for ARDS or ACF requiring ECMO were prospectively included. Daily lipoprotein levels and short-term prognosis outcome were assessed. 25 patients were included. On admission, lipoprotein concentrations were low, under the reference values ([HDL-C] = 0.6[0.4–0.8]mmol/L;[LDL-C] = 1.3[1.0–1.7]mmol/L). A statistically significant rise in lipoproteins overtime was observed during the ICU stay. We found no relationship between lipoproteins concentrations and mortality on Day-28 (p = 0.689 and p = 0.979, respectively). Comparison of surviving patients with non-surviving patients did not reveal any differences in lipoproteins concentrations. Stratification between septic and non-septic patients demonstrated that septic patients had lower lipoproteins concentrations on admission (HDL-C: 0.5[0.3–0.6]mmol/l vs 0.8[0.6–0.9]mmol/l, p = 0.003; LDL-C: 1.1[0.9–1.5]mmol/l vs 1.5[1.3–2.6]mmol/l; p = 0.012), whereas these two groups were comparable in terms of severity and outcomes. HDL-C concentrations during ICU hospitalization were also significantly lower in the septic group than in the non-septic group (p = 0.035). In conclusion, Lipoprotein concentrations are low in patients requiring ECMO but are not associated with poor outcomes. The subpopulation of septic patients had lower lipoprotein levels overtime, which reinforces the potential key-role of these particles during sepsis.

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Integrated omics analysis revealed the Tinospora cordifolia intervention modulated multiple signaling pathways in hypertriglyceridemia patients-a pilot clinical trial

Shirolkar

Yadav

Nale

et al. 2022

J Diabetes Metab Disord

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The Incidence of Propofol-Induced Hypertriglyceridemia and Identification of Associated Risk Factors

Abstract: Supplemental Digital Content is available in the text.

Cited by 20 publications

References 22 publications

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

The Safety of Continuous Infusion Propofol in Mechanically Ventilated Adults With Coronavirus Disease 2019

Lipoprotein concentration in patients requiring extracorporeal membrane oxygenation

Integrated omics analysis revealed the Tinospora cordifolia intervention modulated multiple signaling pathways in hypertriglyceridemia patients-a pilot clinical trial

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