ABSTRACT
Sepsis, as it is known, is frequently seen in intensive care units and may have high mortality and morbidity. Sepsis causes significant changes in carbohydrate and protein metabolism, especially in lipid metabolism. It causes changes in chylomicrone, very low density lipoprotein, low density lipoprotein and high density lipoprotein levels, leading to hypertriglyceridemia and hypocholesterolemia in the foreground. This change in lipid metabolism also increases the risk of atherosclerosis. Hypertriglyceridemia and hypocholesterolemia observed in sepsis is an expected response, such as an increase in fever and acute phase reactants, which are actually signs of acute inflammation.
References
1Michael OL, Julie LG, Edward JS. National Center for Health Statistics Health. United States:2008.
2Lévesque H, Gancel A, Pertuet S, Czernichow P, Courtois H. Hypocholesterolemia: prevalence,diagnostic and prognostic value. Study in a department of internal medicine. Presse Med 1991;20:1935-8.
3Harvey R,Ferrier D. Lippincott’s Illustrated Reviews: Biochemistry fifth Edition.USA:2011.
4Feingold KR, Krauss RM, Pang M, Doerrler W, Jensen P, Grunfeld C. The hypertriglyceridemia of acquired immunodeficiency syndrome is associated with an increased prevalence of low density lipoprotein subclass pattern BJ Clin Endocrinol Metab 1993;76:1423-7.
5Elmehdawi RR. Hypolipidemia: Word of Caution. Libyan J Med, AOP: 071221.
6Bonville DA, Parker TS, Levine DM, Gordon BR, Hydo LJ, Eachempati SR. The relationships of hypocholesterolemia to cytokine concentrations and mortality in critically ill patients with systemic inflammatory response syndrome. Surg Infect 2004;5:39-49.
7Wilson RF, Barletta JF, Tyburski JG. Hypocholesterolemia in sepsis and critically ill or injured patients. Crit Care 2003;7:413-4.
8Jyotirmoy R, Marcel G. The metabolic response to sepsis: relevance to treatment. Surgery (Oxford) 2012;30:679-86.
9Khardori R, Castillo D. Endocrine and metabolic changes during sepsis: an update. Med Clin North Am 2012;96:1095-105.
10Victor DD, Lisa AF, Elizabeth C, Pedro AMT, Carl BS, Nancy DC et al. Muscle weakness and 5 year survival in acute respiratory distress syndrome survivors. Crit Care Med 2017;45:446-53.
11Stella B, Annalisa M, Elisa P, Alberto T, Bruno F. The Complex Interplay between Lipids, Immune System and Interleukins in Cardio-Metabolic Diseases. Int. J. Mol Sri 2018;19:4058.
12Weerapan K, Min-Sun K, Riaz AM, Kenneth RF, Carl G. Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host. J Lipid Res 2004;45:1169-96.
13Harris HW, Grunfeld C, Feingold KR, Read TE, Kane JP, Jones AL, et al. Chylomicrons alter the fate of endotoxin, decreasing tumor necrosis factor release and preventing death. J Clin Invest 1993;91:1028-34.
14Casas AT, Hubsch AP, Doran JE. Effects of reconstituted high-density lipoprotein in persistent gram-negative bacteremia. Am Surg 1996;62:350-5.
15Feingold KR, Soued M, Staprans I, Gavin LA, Donahue ME, Huang BJ, et al. Effect of tumor necrosis factor (TNF) on lipid metabolism in the diabetic rat. Evidence that inhibition of adipose tissue lipoprotein lipase activity is not required for TNF-induced hyperlipidemia. J Clin Invest 1989;83:1116-21.
16Feingold KR, Hardardottir I, Memon R, Krul EJ, Moser AH, Taylor JM et al. Effect of endotoxin on cholesterol biosynthesis and distribution in serum lipoproteins in Syrian hamsters. J Lipid Res 1993;34:2147-58.
17Nonogaki K, Moser AH, Pan XM, Staprans I, Grunfeld C, Feingold KR. Lipoteichoic acid stimulates lipolysis and hepatic triglyceride secretion in rats in vivo. J Lipid Res 1995;36:1987-95.
18Takeyama N, Itoh Y, Kitazawa Y, Tanaka T. Altered hepatic mitochondrial fatty acid oxidation and ketogenesis in endotoxic rats. Am J Physiol 1990;259:498-505.
19Boison D.New insights into the mechanisms of the ketogenic diet. Curr Opin Neurol 2017;30:187-92.
20Sang HL, Moo SP, Byung HP, Won JJ, In SL, Song YK, et al. Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis. BioMed Research International 2015;1-8.
21Lee SH, Lee JY, Hong TH, Kim BO, Lee YJ, Lee JG. Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts inhospital mortality in critically ill patients with diffuse peritonitis. PLoS ONE 2018;13:e0200187
22Segal AZ, Chiu RI, Eggleston-Sexton PM, Beiser A, Greenberg SM. Low cholesterol as a risk factor for primary intracerebral hemorrhage: a case-control study. Neuroepidemiology 1999;18:185-93.
23Marik PE. Dyslipidemia in the critically ill. Crit Care Clin 2006;22:151-9.
24Vermont CL, den Brinker M, Kâkeci N, de Kleijn ED, de Rijke YB, Joosten KF. Serum lipids and disease severity in children with severe meningococcal sepsis. Crit Care Med 2005;33:1610-5.
25Shores J, Peterson J, VanderJagt D, Glew RH. Reduced cholesterol levels in African-American adults with sickle cell disease. J Natl Med Assoc 2003;95:813-7.
26Ichikawa Y, Tokunaga N, Kakizoe Y, Tanaka Y, Ninomiya H, Tanaka M. Host factors which influence the outcome of pneumonia in the elderly. Nihon Kyobu Shikkan Gakkai Zasshi 1992;30:209-15.
27Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D. Prognosis in intraabdominal infections. Multivariate analysis on 604 patients. Arch Surg 1996;131:641-5.
28Fraunberger P, Hahn J, Holler E, Walli AK, Seidel D. Serum cholesterol levels in neutropenic patients with fever. Clin Chem Lab Med 2002;40:304-7.
29Tomiki Y, Suda S, Tanaka M, Okuzawa A, Matsuda M, Ishibiki Y, et al. Reduced low-densitylipoprotein cholesterol causing low serum cholesterol levels in gastrointestinal cancer: a case control study. J Exp Clin Cancer Res 2004;23:233-40.
30Feingold KR, Soued M, Serio MK, Adi S, Moser AH, Grunfeld C. The effect of diet on tumor necrosis factor stimulation of hepatic lipogenesis. Metabolism 1990;39:623-32.
31Havel RJ. Remnant lipoproteins as therapeutic targets. Curr. Open Lipidol 2000;11:615-20.
32Malloy MJ, Kane JP. A risk factor for atherosclerosis: triglyceride-rich lipoproteins. Adv Intern Med 2001;47:111-36.
33Ginsberg HN. New perspectives on atherogenesis: role of abnormal triglyceride-rich lipoprotein metabolism. Circulation 2002;106:2137-42.
34Chait A, Brazg RL, Tribble DL, Krauss RM. Susceptibility of small, dense, low-density lipoproteins to oxidative modification in subjects with the atherogenic lipoprotein phenotype pattern. B Am J Med 1993;94:350-6.
35Schissel SL, Tweedie-Hardman J, Rapp JH, Graham G, Williams KJ, Tabas I. Rabbit aorta and human atherosclerotic lesions hydrolyze the sphingomyelin of retained low-density lipoprotein. Proposed role for arterial-wall sphingomyelinase in subendothelial retention and aggregation of atherogenic lipoproteins. J Clin Invest 1996;98:1455-64.
36Khovidhunkit W, Shigenaga JK, Moser AH, Feingold KR, Grunfeld C. Cholesterol efflux by acute-phase high density lipoprotein. Role of lecithin:cholesterol acyltransferase. J Lipid Res 2001;42:967-75.
37Khovidhunkit W, Moser AH, Shigenaga JK, Grunfeld C, Feingold KR. Regulation of scavenger receptor class B type I in hamster liver and Hep3B cells by endotoxin and cytokines. J Lipid Res 2001;42:1636-44.
38De Nardo D, Labzin LI, Kono H, Seki R, Schmidt SV, Beyer M, et al. High-density lipoprotein mediates anti-inflammatory reprogramming of macrophages via the transcriptional regulator ATF3. Nat Immunol 2014;15:152-60.
