Low serum concentration of apolipoprotein A-I is an indicator of poor prognosis in cirrhotic patients with severe sepsis

Ming Hung Tsai, Yun Shing Peng, Yung Chang Chen, Jau Min Lien, Ya Chung Tian, Ji Tseng Fang, Hsu Huei Weng, Pang Chi Chen, Chih Wei Yang, Cheng Shyong Wu*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

56 Scopus citations

Abstract

Background/Aims: Severe sepsis is frequently associated with hypocholesterolemia which is also a common finding in cirrhotic patients. Lipoprotein is capable of binding endotoxin to which cirrhotic patients exhibit an excessive pro-inflammatory response. Methods: We evaluated the relationship between lipid levels, inflammatory cytokines and clinical outcomes in 103 cirrhotic patients with severe sepsis. Results: The non-survivors had significantly lower concentrations of total cholesterol, high-density lipoprotein (HDL), and apolipoprotein A-I (APO A-I). HDL and APO A-I levels were inversely correlated with interleukin-6, tumor necrosis factor-α, and various disease severity scores. Serum creatinine, mean arterial pressure and low level of APO A-I (<47.5 mg/dl) were independent factors to predict 90-day mortality. The cumulative survival rates at 90 days were 63.8% and 8.9% for the high APO A-I and low APO A-I groups (p < 0.0001). Low APO A-I was also associated with lower mean arterial pressure, higher rate of vasopressor dependency, and greater plasma renin activity. Conclusions: Serum levels of HDL and APO A-I are inversely correlated with liver reserve and disease severity in cirrhotic patients with severe sepsis. Low level of APO A-I is associated with a marked impairment of effective arterial volume, multiple organ dysfunction and a poor prognosis.

Original languageEnglish
Pages (from-to)906-915
Number of pages10
JournalJournal of Hepatology
Volume50
Issue number5
DOIs
StatePublished - 05 2009

Keywords

  • Apolipoprotein A-I liver cirrhosis
  • HDL
  • Severe sepsis

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