title: Low apolipoprotein A-I level at intensive care unit admission and systemic inflammatory response syndrome exacerbation.
abstract: OBJECTIVE
  Examine whether a low serum level of apolipoprotein A-I at intensive care unit (ICU) admission is associated with a further increase of the number of systemic inflammatory response syndrome (SIRS) criteria.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A 20-bed, university-affiliated, surgical ICU.
  
  
  METHODS
  Patients admitted after major surgery, multiple trauma, or acute pancreatitis without septic shock.
  
  
  METHODS
  We defined as the SIRS Exacerb group patients who presented a further increase of the number of SIRS criteria during their ICU stay or, in the presence of four SIRS criteria at ICU admission, those who presented a further aggravation of organ failure. Other patients were attributed to the SIRS No Exacerb group. From day 1 to 6, we measured apolipoprotein A-I, high-density lipoprotein and total cholesterol, triglycerides, C-reactive protein, procalcitonin, serum amyloid A, interleukin 6, interleukin-1 receptor antagonist, albumin, and other nutrition-linked variables. We looked at laboratory values or factors present at ICU admission according to the two groups.
  
  
  RESULTS
  From 63 patients analyzed, 29 (46%) were assigned to the SIRS Exacerb group. Age, sex, and SAPS II and SIRS scores at ICU admission did not differ between the groups. Patients in the SIRS Exacerb group presented more often a septic event (5/29 vs. 0/34, p =.02), had a higher hospital mortality (6/29 vs. 0/34, p =.007), and had a longer ICU stay (p =.0023). At admission, inflammatory variables such as the C-reactive protein, serum amyloid A, interleukin 6, interleukin-1 receptor antagonist plasma levels, and other lipid or nutrition-linked variables were similar between the two groups. Apolipoprotein A-I levels were lower in the SIRS Exacerb group (median [interquartile range]: 68 [56-81] vs. 84 [69-94] mg/dL, p =.028).
  
  
  CONCLUSIONS
  A low serum level of apolipoprotein A-I at ICU admission is associated with an increase of the number of SIRS criteria during the ICU stay.
authors.affiliation: Division of Surgical Intensive Care, Department of Anesthesiology, Pharmacology, and Surgical Intensive Care, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Catherine
authors.initials: C
authors.lastname: Chenaud
authors.forename: Paolo G
authors.initials: PG
authors.lastname: Merlani
authors.forename: Pascale
authors.initials: P
authors.lastname: Roux-Lombard
authors.forename: Danielle
authors.initials: D
authors.lastname: Burger
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
authors.forename: Samuel
authors.initials: S
authors.lastname: Luyasu
authors.forename: Jean-Daniel
authors.initials: JD
authors.lastname: Graf
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Dayer
authors.forename: Bara
authors.initials: B
authors.lastname: Ricou
mesh_terms: D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007109:Immunity / Q000502:physiology; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007378:Interleukins / Q000097:blood; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013557:Switzerland / Q000453:epidemiology; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D016632:Apolipoprotein A-I; D015415:Biomarkers; D007378:Interleukins