The Effect Of The Plasma Lipid Level On The Prognosis In The Patients With Sepsis

ObjectiveTo observe the relationship between the plasma lipid level and theprognosis of patients with sepsis, and to investigate the influence ofplasma lipid to the prognosis in the patients with sepsis.MethodsThe 25 people were selected as a control group. Sixteen of them havethe history of coronary heart disease, the others are health. The 40patients who met sepsis criteria according to 2001SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definition Conference, werechosen for study after they were addmitted to the ICU of Tianjin medicaluniversity general hospital from October 2005 to November 2006. Thepatinets with previous history of hypercholesterolemia, hypertension,diabetes mellitus, liver disease, kidney disease and thyroid disease,previous history of have medicine influencing cholesterol metabolism inrecent 3 monthes were excluded. We collected plasma cholesterol level fromthe control groupe after they had fasting for 12 hours. We collectedclinical variables of the patients with sepsis after they werehospitalized within 24 hours, calculating APACHEⅡscore, based on asingal factor logistic regression analysis to define the risk factors,then we performed the multinomial logistic regression analysis and found independent risk factors which had important effect on clinicalprognosis. There are two independent risk factors: plasma HDL andAPACHEⅡscore. We divided the 40 patients with sepsis into two groups(nonsurvisor group and survisor group) according to the prognosis andcompared the clinical variables difference between the two groups. We alsoused receiver-operating-charateristic (ROC) analysis in plamsma HDL andAPACHEⅡscore for the prognosis.ResultsBetween the control group and the sepsis group, there are differencein TC (sepsis group 3.923±0.9625mmol/L, control 4.396±0.5504 mmol/L,P＜0.05), HDL(sepsis group 1.0967±0.3939 mmol/L, control group1.6056±0.4153mmol/L, P＜0.01), LDL(sepsis group 2.4397±0.8086mmol/L,control group 2.7904±0.4677 mmol/L, P＜0.05), apo-B (sepsis group1.0325±0.2724g/L, control group 1.134±0.1192g/L, P＜0.05), Lp (a)(sepsis group 29.525±21.4318mg/ml, control group 14.572±7.9777 mg/ml,P＜0.01), FFA (sepsis group 0.4798±2.114 mmol/L, control group0.3448±0.1321 mmol/L, P＜0.01), hs-CRP (sepsis group 11.472±4.658mmol/L, control group 7.567±4.0534 mmol/L, P＜0.01)。There are difference in plasma TC, HDL, LDL, apo- Al, apo- B, Lp(a), FFA, hs-CRP, platelet counts, album, glucose and APACHEⅡscore betweennonsurvivors and survivors. In the sepsis group, plasma HDL andAPACHEⅡscore are two independent risk factors in the patients with sepsisbut there are no correlation between plasma HDL and APACHEⅡscore. Inmultinomial logistic regression the B value are HDL=-6.222, APACHEⅡ=0.337. It shows that plasma HDL have more influence to theprognosis of the patients with sepsis. At the same time, we performed thebivariate correlations analysis between APACHEⅡscore and clinicalvariables founding there are correlation between APACHEⅡscore and,Album (r=-0.457, P＜0.01), TC (r=-0.384, P＜0.05), apo-B (r=-0.344, P＜0.05), hs-CRP (r=0.506, P＜0.01), FFA (r=0.426, P＜0.01).Conclusion1. In the patients with sepsis, the lipid metabolism often changes. Theplasma level of TC, HDLand LDL are lower than control group, but the plasmalevel of Lp (a), FFA, hs-CRP are higher in this study.2. According to the plasma HDL level and APACHEⅡscore, we can predictthe prognosis of the patients with sepsis effectively. The low plasma HDLlevel and high APACHEⅡscore are predictors of a poor prognosis in thepatients with sepsis.3. APACHEⅡscore is effected by the plasma level of TC and hs-CRP inthe patients with sepsis. Low plasma TC level and high hs-CRP level canlead to high APACHEⅡscore, that is to say the patients with sepsis havea worse prognosis.