Low serum concentration of apolipoprotein A-I is an indicator of poor prognosis in cirrhotic patients with severe sepsis.
OBJECTIVE
Severe sepsis is frequently associated with hypocholesterolemia which is also a common finding in cirrhotic patients. Lipoprotein is capable of binding endotoxin to which cirrhotic patients exhibit an excessive pro-inflammatory response.


METHODS
We evaluated the relationship between lipid levels, inflammatory cytokines and clinical outcomes in 103 cirrhotic patients with severe sepsis.


RESULTS
The non-survivors had significantly lower concentrations of total cholesterol, high-density lipoprotein (HDL), and apolipoprotein A-I (APO A-I). HDL and APO A-I levels were inversely correlated with interleukin-6, tumor necrosis factor-alpha, and various disease severity scores. Serum creatinine, mean arterial pressure and low level of APO A-I (<47.5mg/dl) were independent factors to predict 90-day mortality. The cumulative survival rates at 90 days were 63.8% and 8.9% for the high APO A-I and low APO A-I groups (p<0.0001). Low APO A-I was also associated with lower mean arterial pressure, higher rate of vasopressor dependency, and greater plasma renin activity.


CONCLUSIONS
Serum levels of HDL and APO A-I are inversely correlated with liver reserve and disease severity in cirrhotic patients with severe sepsis. Low level of APO A-I is associated with a marked impairment of effective arterial volume, multiple organ dysfunction and a poor prognosis.
Tsai
Ming-Hung
MH
Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Peng
Yun-Shing
YS
Chen
Yung-Chang
YC
Lien
Jau-Min
JM
Tian
Ya-Chung
YC
Fang
Ji-Tseng
JT
Weng
Hsu-Huei
HH
Chen
Pang-Chi
PC
Yang
Chih-Wei
CW
Wu
Cheng-Shyong
CS
D000328:Adult; D000368:Aged; D016632:Apolipoprotein A-I / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies; D012083:Renin / Q000097:blood; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D016632:Apolipoprotein A-I; D015415:Biomarkers; D008076:Cholesterol, HDL; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein; D003404:Creatinine; D012083:Renin