Effect of low high-density lipoprotein levels on mortality of septic patients: A systematic review and meta-analysis of cohort studies

doi:10.5847/wjem.j.1920-8642.2020.02.008

Abstract

Abstract:

BACKGROUND: An increase in high-density lipoprotein (HDL) is well associated with a decreased cardiovascular risk, especially atherosclerosis. Recent studies suggest that lower levels of HDL may also be associated with an increased risk of sepsis and an increased rate of mortality in septic patients. However, this conclusion remains controversial.

METHODS: MEDLINE, EMBASE, and CENTRAL databases were searched from inception to September 30, 2019. All studies were conducted to evaluate the correlation of lipoprotein levels and the risk and outcomes of sepsis in adult patients. The primary outcomes were the risk and mortality of sepsis.

RESULTS: Seven studies comprising 791 patients were included. Lower levels of HDL had no marked relevance with the risk of sepsis (odds radio [OR] for each 1 mg/dL increase, 0.94; 95% CI 0.86-1.02; P=0.078), whereas lower HDL levels were related to an increased mortality rate in septic patients (OR for below about median HDL levels, 2.00; 95% CI 1.23-3.24; P=0.005).

CONCLUSION: This meta-analysis did not reveal a significant association between lower HDL levels and an increase in the risk of sepsis, whereas it showed that lower HDL levels are associated with a higher mortality rate in septic adult patients. These findings suggest that HDL may be considered as a promising factor for the prevention and treatment of sepsis in the future.

Key words: High-density lipoprotein, Sepsis, Mortality, Meta-analysis

Shao-hua Liu, Huo-yan Liang, Hong-yi Li, Xian-fei Ding, Tong-wen Sun, Jing Wang. Effect of low high-density lipoprotein levels on mortality of septic patients: A systematic review and meta-analysis of cohort studies[J]. World Journal of Emergency Medicine, 2020, 11(2): 109-116.

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The first author (year)	Country	Study design	No. of population (case/control)	Mean age of patients population	Mean age of control population	Sample source	Source divided into case/control group	Levels of HDL in case/control group (mg/dL)	Study period	Reported outcomes	Source of definition of sepsis/severe sepsis /septic shock
Shor (2008)^[6]	Israel	RC	108/96	66.6	66.3	Serum	Levels of serum HDL	<20 /≥65	01/2005- 12/2005	Risk of sepsis	ACCP/SCCM consensus conference definitions
Genga (2017)^[7]	Canada	OC	11/24	55.8	53.7	Plasma	Levels of serum HDL	<33.06 /≥33.06	01/2011- 07/2013	2-year mortality	Institutional Sepsis Protocol
Chien (2005)^[16]	China	PC	30/33	72.5	72	Serum	Levels of serum HDL	<20 /≥20	10/2002- 01/2003	30-day mortality	ACCP/SCCM consensus conference definitions
Lekkou (2014)^[18]	Greece	PC	28/22	64.8	66.2	Serum	Levels of serum HDL	<25 /≥25	NA	Mortality	SIRS
Grion (2010)^[23]	Brazil	PC	51/71	65.81	65.12	Serum	Levels of serum HDL	33.07 /40.33	05/2005- 12/2005	Risk of sepsis	ACCP/SCCM consensus conference definitions
Cirstea (2017)^[24]	Canada	OC	68/132	56.5	55.9	Serum	Levels of serum HDL	<25.1 /≥25.1	01/2011- 06/2014	28-day mortality	Suspected sepsis protocol
Lee (2015)^[25]	South Korea	PC	65/52	63	62.3	Serum	Survivors/non-survivors	21 /21	08/2008- 12/2008	Mortality	The identification of an infection site + three or four SIRS

Author	Selection			Comparability			Assessment of outcome			Total quality score
Author	Representativeness of exposure arm(s)	Selection of the comparative arm(s)	Origin of exposure source	Demonstration that outcome of interest was not present at start of study	Studies controlling the most important factors	Studies controlling the other main factors	Assessment of outcome with independency	Adequacy of follow-up length (to assess outcome)	Lost to follow-up acceptable (less than 10% and reported)	Total quality score
Shor (2008)^[6]	*	*	*	*	*	*	-	*	-	7
Genga (2017)^[7]	*	*	*	*	*	-	*	*	-	7
Chien (2005)^[16]	*	*	*	*	*	*	-	*	-	7
Lekkou (2014)^[18]	*	*	*	*	*	-	*	*	-	7
Grion (2010)^[23]	*	*	*	*	*	*	*	*	-	8
Cirstea (2017)^[24]	*	-	*	*	*	*	*	*	-	7
Lee (2015)^[25]	*	*	*	*	*	*	*	*	-	8

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