title: Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment.
abstract: OBJECTIVE
  The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects.
  
  
  METHODS
  We studied 182 patients with systemic inflammatory response syndrome/severe sepsis or shock during the acute (day 1) and subacute phase of critical illness (day 6). All subjects had a tissue microdialysis (MD) catheter placed in femoral adipose tissue upon admission to the intensive care unit (ICU). Plasma cholesterol, high-density lipoprotein, low-density lipoprotein, free fatty acids (FFAs), triglyceride, and MD glycerol (GLYC) were measured on days 1 and 6 in the ICU.
  
  
  RESULTS
  On admission, 56% of the patients had increased levels (>200 μmol/L) of MD GLYC. Patients with shock displayed more pronounced subcutaneous tissue lipolysis and more profound derangements of circulating lipids vs patients without shock (but no appreciable differences in FFA levels). Furthermore, in patients with shock during the acute period, there were positive, albeit weak, correlations of subcutaneous tissue lipolysis (MD GLYC), plasma FFAs (r=0.260; P=.01), and norepinephrine's dose (r=0.230; P=.01), whereas during the subacute phase, MD GLY levels were higher in patients receiving glucocorticoids (344.7±276.0 μmol/L vs 252.2±158.4 μmol/L; P=.03).
  
  
  CONCLUSIONS
  Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.
authors.affiliation: Endocrine Department, E. Venizelou Hospital, Athens, Greece. Electronic address: iiliasmd@yahoo.gr.
authors.forename: I
authors.initials: I
authors.lastname: Ilias
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: D A
authors.initials: DA
authors.lastname: Vassiliadi
authors.affiliation: Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Theodorakopoulou
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Boutati
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Maratou
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Mitrou
authors.affiliation: Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: N
authors.initials: N
authors.lastname: Nikitas
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Apollonatou
authors.affiliation: Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Dimitriadis
authors.affiliation: Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Armaganidis
authors.affiliation: Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Dimopoulou
mesh_terms: D000208:Acute Disease; D000273:Adipose Tissue / Q000378:metabolism; D000328:Adult; D000368:Aged; D002784:Cholesterol / Q000097:blood; D016638:Critical Illness; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005990:Glycerol / Q000097:blood; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007362:Intensive Care Units; D050356:Lipid Metabolism; D008066:Lipolysis; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D017551:Microdialysis; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D011446:Prospective Studies; D018805:Sepsis / Q000378:metabolism*; D012769:Shock / Q000378:metabolism*; D018709:Statistics, Nonparametric; D050151:Subcutaneous Fat / Q000378:metabolism; D018746:Systemic Inflammatory Response Syndrome / Q000378:metabolism*; D014280:Triglycerides / Q000097:blood
chemical_list: D005230:Fatty Acids, Nonesterified; D007328:Insulin; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL; D014280:Triglycerides; D002784:Cholesterol; D005990:Glycerol; D009638:Norepinephrine
keywords: Intensive care units; Lipolysis; Microdialysis; Sepsis