Predictive Value Of SOFA Score Combined HDL In Elderly Patients With Sepsis

Objective High-density lipoprotein(HDL)was first discovered by Michel Macheboeuf in 1929.HDL is a mixture of different lipoprotein particles,which are heterogeneous in size,lipid and apolipoprotein composition,with a density between 1.063 and 1.210 g/ml,and mature spherical high-density lipoprotein contains 45–55% apoproteins,26–32% phospholipids,15–20% esterified cholesterol,3–5% free cholesterol and 5% triglyceride.Variations in apolipoprotein content of these particles set the basis for functional heterogeneity of HDL between individuals.In addition to anti-atherosclerosis and coronary heart disease,recent data indicate that HDL play pivotal role in other diseases such as morbid obesity,nonalcoholic fatty liver,type 2 diabetes,bone metabolic diseases,inflammation,obstructive pulmonary disease,and numerous diseases of central nervous system diseases.Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.This study compared HDL,sequential organ failure assessment(SOFA)score,acute physiology and chronic health evaluation II(APACHE II)score and other biomarkers to investigate whether HDL can predict 28-day mortality in elderly patients with sepsis,and to explore the predictive value of SOFA score combined with HDL for prognosis in critical elderly patients with sepsis.Methods A retrospective analysis was conducted.Elderly patients aged 80 years or older admitted to the Geriatric Intensive Care Unit(GICU)of the Tianjin Medical University General Hospital from January 2017 to November 2018 were enrolled.Age,gender,APACHE II score,SOFA score at admission,biochemical indicators such as white blood cell count(WBC),platelet count(PLT),hemoglobin(Hb),triglyceride(TG),cholesterol(TC),high-density lipoprotein(HDL),low-density lipoprotein(LDL),albumin(ALB),lactic(Lac)levels,serum procalcitonin(PCT),C-reactive protein(CRP),length of ICU stay,underlying diseases such as hypertension,coronary heart disease,diabetes,cerebral hemorrhage,cerebral infarction,usage of mechanical ventilation and renal replacement therapy were recorded.The primary clinical end point was 28-day mortality.Risk factors for death in elderly patients with sepsis were analyzed by binary logistic regression analysis.Predictive value of each scoring system for prognosis in elderly patients with sepsis were used the receiver operating characteristic curve(ROC).Results A total of 110 elderly patients with sepsis older than 80 years old were enrolled.69 patients died in 28 days after the admission,the 28-mortality rate was 62.7%.Non-survivors presented a higher age,PT,APTT,PCT,Lac,SOFA score,APACHE II score,longer usage of mechanical ventilation,and higher proportion of vasoactive drugs than that of survivors,but TC,HDL,LDL and cerebral hemorrhage were lower than survivors;HDL,SOFA score and APACHE II score associated with 28-day mortality in binary logistic regression analysis(both P < 0.05).The area under the ROC curve(AUC)of SOFA score combined HDL was higher than SOFA score and APACHE II scores [(0.905(0.852-0.958)vs.0.886(0.028-0.945),0.889(0.825-0.945),all P<0.01].The Youden index(70.9)of SOFA score combined HDL was the largest,with a sensitivity of 78.3% and a specificity of 92.7%.Conclusion In elderly patients with sepsis,HDL is an independent risk factor for 28-day mortality.The combination of SOFA score and HDL enable accurate prediction in elderly patients with sepsis.