荟萃分析
观察研究
败血症
医学
危重病
内科学
重症监护医学
病危
作者
Rory Taylor,Chengyuan Zhang,Deepu George,Sailesh Kotecha,Mariam Abdelghaffar,Thorsten Forster,Patrícia Rodrigues,Alexander C. Reisinger,Daniel A. White,Fergus Hamilton,William J. Watkins,David Griffith,Peter Ghazal
出处
期刊:EBioMedicine
[Elsevier]
日期:2024-02-01
卷期号:100: 104981-104981
被引量:1
标识
DOI:10.1016/j.ebiom.2024.104981
摘要
Summary
Background
Mechanistic studies have established a biological role of sterol metabolism in infection and immunity with clinical data linking deranged cholesterol metabolism during sepsis with poorer outcomes. In this systematic review we assess the relationship between biomarkers of cholesterol homeostasis and mortality in critical illness. Methods
We identified articles by searching a total of seven electronic databases from inception to October 2023. Prospective observational cohort studies included those subjects who had systemic cholesterol (Total Cholesterol (TC), HDL-C or LDL-C) levels assessed on the first day of ICU admission and short-term mortality recorded. Meta-analysis and meta-regression were used to evaluate overall mean differences in serum cholesterol levels between survivors and non-survivors. Study quality was assessed using the Newcastle–Ottawa Scale. Findings
From 6469 studies identified by searches, 24 studies with 2542 participants were included in meta-analysis. Non-survivors had distinctly lower HDL-C at ICU admission −7.06 mg/dL (95% CI −9.21 to −4.91, p < 0.0001) in comparison with survivors. Corresponding differences were also seen less robustly for TC −21.86 mg/dL (95% CI −31.23 to −12.49, p < 0.0001) and LDL-C −8.79 mg/dL (95% CI, −13.74 to −3.83, p = 0.0005). Interpretation
Systemic cholesterol levels (TC, HDL-C and LDL-C) on admission to critical care are inversely related to mortality. This finding is consistent with the notion that inflammatory and metabolic setpoints are coupled, such that the maladaptive-setpoint changes of cholesterol in critical illness are related to underlying inflammatory processes. We highlight the potential of HDL-biomarkers as early predictors of severity of illness and emphasise that future research should consider the metabolic and functional heterogeneity of HDLs. Funding
EU-ERDF-Welsh Government Ser Cymru programme, BBSRC, and EU-FP7 ClouDx-i project (PG).
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