Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock

• Published in: Nutrition (Burbank, Los Angeles County, Calif.) Los Angeles County, Calif.), 2018-03, Vol.47, p.104-109
• Main Authors: Bermudes, Ana Carolina G., de Carvalho, Werther B., Zamberlan, Patricia, Muramoto, Giovana, Maranhão, Raul C., Delgado, Artur F.
• Format: Article
• Language: English
• Subjects: Apolipoprotein A-I - blood; Apolipoproteins; Biomarkers - blood; C-reactive protein; C-Reactive Protein - analysis; Child, Preschool; Cholesterol; Cholesterol - blood; Critical Illness - mortality; Emergency medical services; Emergency response; Female; High density lipoprotein; Humans; Infant; Inflammation; Inflammatory response; Intensive care units; Intensive Care Units, Pediatric - statistics & numerical data; Lipid Metabolism; Lipids; Lipoproteins; Lipoproteins, HDL - blood; Low density lipoprotein; Male; Malnutrition; Metabolism; Mortality; Observational studies; Patient Admission - statistics & numerical data; Patients; Pediatric; Pediatrics; Prospective Studies; Sepsis; Sepsis - blood; Septic shock; Serum levels; Shock, Septic - blood; Systemic inflammatory response syndrome; Triglycerides; Triglycerides - blood
• ISSN: 0899-9007; 1873-1244
• DOI: 10.1016/j.nut.2017.09.015

Limited knowledge exists regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome. The aim of this study was to evaluate the relationship between the intensity of the inflammatory response and changes in the lipid profiles of critically ill pediatric patients admitted to a pediatric intensive care unit (PICU) with severe sepsis/septic shock. This was a prospective and observational study at a 15-bed PICU at a public university hospital. We analyzed the lipid profiles of 40 patients with severe sepsis/septic shock admitted to the PICU on the first and seventh days of hospitalization. C-reactive protein was used as a marker for systemic inflammation. Forty-two pediatric patients seen in the emergency department and without systemic inflammatory response syndrome were used to provide control values. On day 1 of admission to the PICU, the patients had significantly lower levels of total cholesterol (TC), high-density lipoprotein (HDL), and low-density lipoprotein (LDL) as well as higher concentrations of triacylglycerols compared with the control group. There was a significant increase in the TC, HDL, LDL, and apolipoprotein levels from day 1 to day 7 of the study. During severe sepsis/septic shock, we found lower serum levels of lipoproteins and apolipoproteins, and these were negatively correlated with C-reactive protein. As the inflammatory response improved, the levels of TC, HDL, LDL, and apolipoproteins increased, suggesting a direct relationship between changes in the lipid profiles and inflammation. •There is limited knowledge regarding the lipid profiles of critically ill pediatric patients with systemic inflammatory response syndrome.•The aim of this study was to evaluate whether changes in lipid profiles were present in children admitted to a pediatric intensive care unit with a clinical diagnosis of severe sepsis/septic shock on the first day and whether these changes were attenuated according to clinical improvement.•The present study results suggested that in septic pediatric patients, a negative correlation existed between the severity of inflammation (as measured by serum C-reactive protein values) and total cholesterol, high-density lipoprotein, and apolipoprotein A-1 levels.•The present data demonstrated that reduced levels of lipoproteins and apolipoproteins at intensive care unit admission were significantly increased during the study. In contrast, C-reactive protein levels decreased fro