title: Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients.
abstract: BACKGROUND
  Oxidative stress affects clinical outcome in critically ill patients. Although high-density lipoprotein (HDL) particles generally possess anti-oxidant capacities, deleterious properties of HDL have been described in acutely ill patients. The impact of anti-oxidant HDL capacities on clinical outcome in critically ill patients is unknown. We therefore analyzed the predictive value of anti-oxidant HDL function on mortality in an unselected cohort of critically ill patients.
  
  
  METHODS
  We prospectively enrolled 270 consecutive patients admitted to a university-affiliated intensive care unit (ICU) and determined anti-oxidant HDL function using the HDL oxidant index (HOI). Based on their HOI, the study population was stratified into patients with impaired anti-oxidant HDL function and the residual study population.
  
  
  RESULTS
  During a median follow-up time of 9.8 years (IQR: 9.2 to 10.0), 69% of patients died. Cox regression analysis revealed a significant and independent association between impaired anti-oxidant HDL function and short-term mortality with an adjusted HR of 1.65 (95% CI 1.22-2.24; p = 0.001) as well as 10-year mortality with an adj. HR of 1.19 (95% CI 1.02-1.40; p = 0.032) when compared to the residual study population. Anti-oxidant HDL function correlated with the amount of oxidative stress as determined by Cu/Zn superoxide dismutase (r = 0.38; p<0.001).
  
  
  CONCLUSIONS
  Impaired anti-oxidant HDL function represents a strong and independent predictor of 30-day mortality as well as long-term mortality in critically ill patients.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Lore
authors.initials: L
authors.lastname: Schrutka
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
authors.affiliation: Department of Internal Medicine IV, Kaiser-Franz-Josef-Hospital Vienna, Vienna, Austria.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Meyer
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Raphael
authors.initials: R
authors.lastname: Wurm
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Koller
authors.affiliation: University Clinic of Orthopedics, Paracelsus Medical University Salzburg, Salzburg, Austria.
authors.forename: Lukas
authors.initials: L
authors.lastname: Kriechbaumer
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Richard
authors.initials: R
authors.lastname: Pacher
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Klaus
authors.initials: K
authors.lastname: Distelmaier
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Martin
authors.initials: M
authors.lastname: Hülsmann
mesh_terms: D000368:Aged; D000975:Antioxidants / Q000378:metabolism*; D001317:Austria / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood; D002423:Cause of Death; D016638:Critical Illness / Q000401:mortality; D003953:Diagnosis-Related Groups; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000378:metabolism; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D008075:Lipoproteins, HDL / Q000097:blood / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000975:Antioxidants; D008075:Lipoproteins, HDL