Abstract
A decrease in plasma lipids occurs during severe sepsis and has prognostic implications in critical illness. Whether lipids have prognostic implications or could help to differentiate community-acquired pneumonia from other lower respiratory tract infections remains unknown. We analysed data from patients with lower respiratory tract infections enrolled in four prospective trials. We studied the time courses of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) and compared them with the underlying diagnosis and medical outcomes. Of 572 patients included, 372 had community-acquired pneumonia and 200 acute and exacerbations of chronic obstructive bronchitis. We found significantly lower concentrations of TC, LDL-C and HDL-C in all patients on admission as compared to hospital discharge, particularly in community-acquired pneumonia. A multivariate logistic regression analysis including HDL-C, CRP, age and diabetes showed that HDL-C (OR: 0.18 [95%CI 0.11-0.3]) and CRP (OR: 1.01 [95%CI 1.01-1.02]) were independent predictors of community-acquired pneumonia. TC levels were significantly lower in non-survivors than in survivors (3.26 mmol/L [95%CI 2.58-3.96] vs 3.78 mmol/L [95%CI 3.01-4.65]). The prognostic accuracy, defined as the area under the receiver operator characteristic curve of TC to predict mortality, was 0.63 (95%CI 0.53-0.72) in all patients and increased to 0.94 (95%CI 0.86-1.00) in patients with bacteraemic community-acquired pneumonia. In conclusion, low lipid levels, particularly low HDL-C, pointed to bacterial infection and low TC was predictive of adverse outcomes in patients with lower respiratory tract infections. Reflecting the severity of disease, plasma lipid levels may be a complementary tool in the diagnostic and prognostic workup of patients with lower respiratory tract infections.
Highlights
In conclusion, low lipid levels, low high-density lipoprotein cholesterol (HDL-C), pointed to bacterial infection and low total cholesterol (TC) was predictive of adverse outcomes in patients with lower respiratory tract infections
This study investigated changes in plasma lipid levels in patients with Lower respiratory tract infection (LRTI), and whether plasma lipids were different in bacterial and non-bacterial LRTI, and whether they have prognostic implications
Lipoproteins bind a wide variety of enveloped and nonenveloped DNA and RNA viruses and are involved in the defence against several parasites [27, 28]. In accordance with these experimental findings the present study demonstrates that in unselected patients with less severe systemic infections cholesterol values on admission are significantly altered depending on disease severity
Summary
HDL-C concentrations were significantly lower in severely ill patients from a medical intensive care unit if an infection was present, and correlated with medical outcomes independently of the underlying diseases [2, 3, 6]. Lower respiratory tract infection (LRTI) summarises a broad and continuous spectrum of diseases including viral bronchitis and community-acquired pneumonia (CAP). Bacterial CAP is the most important precursor of sepsis and the major infection-related cause of death [7]. Assessment of disease severity and prediction of outcome in patients with LRTI is crucial for decision-making on patient management, such as the need for hospital or intensive care admission and suitability for hospital discharge [14, 15]
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