DES PLAINES, Ill. -- Critically ill patients with low blood levels of high-density-lipoprotein (HDL) cholesterol, or good cholesterol, on the first day of severe sepsis have a higher mortality rate according to an article in the August issue of Critical Care Medicine.
"Our study revealed that people with an HDL cholesterol level of <20 mg/dL on day one of severe sepsis were almost 13 times more likely to die within 30 days than those who had a higher HDL level," said co-author Chong-Jen Yu, MD, PhD, of the department of internal medicine at National Taiwan University Hospital and National Taiwan University Medical College in Taipei, Taiwan. "These people also tended to have higher serum cytokines, stayed longer in ICU, contracted hospital-acquired infection and required more life support." Sepsis is the leading cause of death in critically ill patients, and it is fatal for 30 percent to 50 percent of them. Lipoproteins, a family of proteins in human blood that normally bind to lipids, have been found to bind and neutralize toxic germ products, and, therefore, might be beneficial to patients with sepsis.
The researchers measured serum levels of lipids and lipoproteins of 63 patients in the intensive care unit (ICU) of a 2,000-bed, tertiary-level university hospital on the first day of severe sepsis and continued to monitor them for the next 14 days. Patients all met the criteria for severe sepsis as defined by the 1991 American College of Chest Physicians/Society of Critical Care Medicine consensus conference.
The investigators found that patients who on the first day of sepsis had an HDL cholesterol level less than 20mg/dL and apolipoprotein A-1 less than 100mg/dL had a higher rate of overall and sepsis-attributable 30-day mortality. Apolipoproteins are the proteins that deliver fats through the blood. These patients also had an increased risk of prolonged ICU stays (greater than seven days) and hospital-acquired infections.
Although this study appears to help predict the prognosis in severe sepsis, the researchers went on to conduct a cell culture study where they found that a treatment with HDL after the commencement of sepsis was not helpful.
It is not clear whether a lower HDL level in septic patients is only a "bystander phenomenon" or directly causes death by sepsis. It is also unclear whether the HDL levels were already low before sepsis, or consumed by higher amounts of germ toxin, or by the suppression of production by host cytokines.
"We speculated that strategies to achieve a higher HDL cholesterol level before the start of severe sepsis might improve survival rates. Further studies performed with prospective and randomized designs are needed to work out potential therapeutic strategies to achieve high HDL level," said Yu.
The authors concluded that further studies performed with prospective and randomized designs are needed to demonstrate the therapeutic benefits of HDL and its role in sepsis.
In an accompanying editorial, Hobart W. Harris, MD, MPH, notes that the findings in this study are similar to those of previous researchers, but that this one has some important differences. "In the current report, total serum cholesterol levels were not only identical between survivors and non-survivors, but were stable during the 14-day study period. In contrast, HDL cholesterol concentrations did yield a more variable pattern, with levels that were low for the first four days but returned to normal at one week."
Harris, of the department of surgery at the University of California, San Francisco, adds, "The mechanisms governing sepsis-induced changes in lipid metabolism and how lipoproteins protect against infection are incompletely understood." Due to the serious clinical problems that sepsis poses, he concludes that "novel approaches to the treatment of sepsis are essential."
Source: Society of Critical Care Medicine
Stay prepared and protected with Infection Control Today's newsletter, delivering essential updates, best practices, and expert insights for infection preventionists.
Reducing Hidden Risks: Why Sharps Injuries Still Go Unreported
July 18th 2025Despite being a well-known occupational hazard, sharps injuries continue to occur in health care facilities and are often underreported, underestimated, and inadequately addressed. A recent interview with sharps safety advocate Amanda Heitman, BSN, RN, CNOR, a perioperative educational consultant, reveals why change is overdue and what new tools and guidance can help.
New Study Explores Oral Vancomycin to Prevent C difficile Recurrence, But Questions Remain
July 17th 2025A new clinical trial explores the use of low-dose oral vancomycin to prevent Clostridioides difficile recurrence in high-risk patients taking antibiotics. While the data suggest a possible benefit, the findings stop short of statistical significance and raise red flags about vancomycin-resistant Enterococcus (VRE), underscoring the delicate balance between prevention and antimicrobial stewardship.
What Lies Beneath: Why Borescopes Are Essential for Verifying Surgical Instrument Cleanliness
July 16th 2025Despite their smooth, polished exteriors, surgical instruments often harbor dangerous contaminants deep inside their lumens. At the HSPA25 and APIC25 conferences, Cori L. Ofstead, MSPH, and her colleagues revealed why borescopes are an indispensable tool for sterile processing teams, offering the only reliable way to verify internal cleanliness and improve sterile processing effectiveness to prevent patient harm.
The Next Frontier in Infection Control: AI-Driven Operating Rooms
Published: July 15th 2025 | Updated: July 15th 2025Discover how AI-powered sensors, smart surveillance, and advanced analytics are revolutionizing infection prevention in the OR. Herman DeBoard, PhD, discusses how these technologies safeguard sterile fields, reduce SSIs, and help hospitals balance operational efficiency with patient safety.
Targeting Uncertainty: Why Pregnancy May Be the Best Time to Build Vaccine Confidence
July 15th 2025New national survey data reveal high uncertainty among pregnant individuals—especially first-time parents—about vaccinating their future children, underscoring the value of proactive engagement to strengthen infection prevention.