• 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, and Cheng-Shyong Wu.
• Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
• J. Hepatol. 2009 May 1;50(5):906-15.

Background/AimsSevere 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.MethodsWe evaluated the relationship between lipid levels, inflammatory cytokines and clinical outcomes in 103 cirrhotic patients with severe sepsis.ResultsThe 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-alpha, and various disease severity scores. Serum creatinine, mean arterial pressure and low level of APO A-I (<47.5mg/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.ConclusionsSerum 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.

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