title: Low total cholesterol and high total bilirubin are associated with prognosis in patients with prolonged sepsis.
abstract: OBJECTIVE
  Nutritional biochemical indexes are generally used as markers for critically ill patients. However, they are easily influenced by acute phase changes after injury and are difficult to use as common and practical biomarkers. The objective of this study was to determine the most valuable prognostic markers among 15 common laboratory tests in patients with sepsis.
  
  
  METHODS
  We included all sepsis patients who stayed in the intensive care unit for more than 2 weeks. We evaluated 15 biochemistry indexes including serum albumin, total protein, C-reactive protein, cholinesterase, total cholesterol (T-Cho), triglyceride, sodium, potassium, blood urea nitrogen, creatinine, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, total bilirubin (T-Bil), and prothrombin time. The minimum and maximum values of these indexes during the first 14 days from admission were analyzed by classification and regression tree and multivariate logistic regression analyses.
  
  
  RESULTS
  This study comprised 91 patients with sepsis. The primary split was the minimum value of serum T-Cho (T-Cho (Min)), and the cutoff value was 73.5 mg/dL by classification and regression tree analysis. The second split was the maximum value of T-Bil (T-Bil (Max)), and the cutoff value was 1.35 mg/dL. The rate of mortality was 63% (17/27) in the group with T-Cho (Min) less than 73.5 mg/dL and T-Bil (Max) greater than 1.35 mg/dL. Multivariate logistic regression revealed that T-Cho (Min) and T-Bil (Max) were the biomarkers most closely associated with prognosis.
  
  
  CONCLUSIONS
  Total cholesterol and T-Bil could be associated with prognosis in patients with sepsis.
authors.affiliation: Nagasaki University Hospital Emergency Medical Center, Nagasaki 852-8501, Japan. Electronic address: snipeshu@gmail.com.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Yamano
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Electronic address: shimiken@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Electronic address: ogura@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Electronic address: htomoya1979@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Hirose
authors.affiliation: Office of Biostatistics and Data Management, National Cerebral and Cardiovascular Center, Suita, Osaka 565-8565 Japan. Electronic address: toshi.hamasaki@ncvc.go.jp.
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Hamasaki
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan. Electronic address: shimazu@hp-emerg.med.osaka-u.ac.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimazu
authors.affiliation: Nagasaki University Hospital Emergency Medical Center, Nagasaki 852-8501, Japan. Electronic address: tasaki-o@nagasaki-u.ac.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Tasaki
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D001798:Blood Proteins; D001806:Blood Urea Nitrogen; D002097:C-Reactive Protein / Q000032:analysis; D002784:Cholesterol / Q000097:blood*; D002802:Cholinesterases / Q000097:blood; D003404:Creatinine / Q000097:blood; D016638:Critical Illness / Q000401:mortality*; D050171:Dyslipidemias / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006932:Hyperbilirubinemia / Q000453:epidemiology*; D007362:Intensive Care Units; D007770:L-Lactate Dehydrogenase / Q000097:blood; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D018805:Sepsis / Q000097:blood / Q000401:mortality*; D012709:Serum Albumin / Q000032:analysis; D012964:Sodium / Q000097:blood; D014280:Triglycerides / Q000097:blood
chemical_list: D015415:Biomarkers; D001798:Blood Proteins; D012709:Serum Albumin; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol; D012964:Sodium; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D002802:Cholinesterases; D001663:Bilirubin; D011188:Potassium
keywords: Bilirubin; Biomarker; Cholesterol; Classification and regression tree; Nutrition; Sepsis