title: Low lipid concentrations in critical illness: implications for preventing and treating endotoxemia.
abstract: OBJECTIVE
  To determine the prevalence and clinical significance of hypolipidemia found in critically ill patients, and whether the addition of a reconstituted lipoprotein preparation could inhibit the generation of tumor necrosis factor-alpha (TNF-alpha) in acute-phase blood taken from these patients.
  
  
  METHODS
  Surgical intensive care unit (ICU) of a large urban university hospital.
  
  
  METHODS
  Prospective case series.
  
  
  METHODS
  A total of 32 patients with a variety of critical illnesses had lipid and lipoprotein concentrations determined. Six patients and six age- and gender-matched control subjects had whole blood in vitro studies of the effect of lipoprotein on lipopolysaccharide mediated TNF-alpha production.
  
  
  METHODS
  Blood samples were drawn on admission to the ICU and over a subsequent 8-day period.
  
  
  RESULTS
  Mean serum lipid and lipoprotein values obtained from patients within 24 hrs of transfer to the surgical ICU were extremely low: mean total cholesterol was 117 mg/dL (3.03 mmol/L), low-density lipoprotein cholesterol 71 mg/dL (1.84 mmol/L), and high-density lipoprotein cholesterol 25 mg/dL (0.65 mmol/L). Only the mean triglyceride concentration of 105 mg/dL (1.19 mmol/L), and the mean lipoprotein(a) concentration of 25 mg/dL (0.25 g/L) were within the normal range. During the first 8 days following surgical ICU admission, there were trends toward increasing lipid and lipoprotein concentrations that were significant for triglycerides and apolipoprotein B. Survival did not correlate with the lipid or lipoprotein concentrations, but patients with infections had significantly lower (p = .008) high-density lipoprotein cholesterol concentrations compared with noninfected patients. Lipopolysaccharide-stimulated production of TNF-alpha in patient and control blood samples was completely suppressed by the addition of 2 mg/mL of a reconstituted high-density lipoprotein preparation.
  
  
  CONCLUSIONS
  Patients who are critically ill from a variety of causes have extremely low cholesterol and lipoprotein concentrations. Correction of the hypolipidemia by a reconstituted high-density lipoprotein preparation offers a new strategy for the prevention and treatment of endotoxemia.
authors.affiliation: Rogosin Institute, New York, NY 10021, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Gordon
authors.forename: T S
authors.initials: TS
authors.lastname: Parker
authors.forename: D M
authors.initials: DM
authors.lastname: Levine
authors.forename: S D
authors.initials: SD
authors.lastname: Saal
authors.forename: J C
authors.initials: JC
authors.lastname: Wang
authors.forename: B J
authors.initials: BJ
authors.lastname: Sloan
authors.forename: P S
authors.initials: PS
authors.lastname: Barie
authors.forename: A L
authors.initials: AL
authors.lastname: Rubin
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001053:Apolipoproteins / Q000302:isolation & purification / Q000627:therapeutic use; D016638:Critical Illness; D004731:Endotoxins / Q000097:blood*; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008075:Lipoproteins, HDL / Q000302:isolation & purification / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014115:Toxemia / Q000097:blood* / Q000188:drug therapy / Q000517:prevention & control; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis / Q000037:antagonists & inhibitors
chemical_list: D001053:Apolipoproteins; D004731:Endotoxins; D008055:Lipids; D008074:Lipoproteins; D008075:Lipoproteins, HDL; D014409:Tumor Necrosis Factor-alpha