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Serum lipids and disease severity in children with severe meningococcal sepsis.

Abstract：

OBJECTIVE:To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN:Retrospective observational study. SETTING:A university-affiliated pediatric intensive care unit. PATIENTS:Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis or septic shock. INTERVENTIONS:Total cholesterol, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) concentrations were measured in serum samples drawn within 6 hrs after admission to the pediatric intensive care unit and 12, 24, 48, 72 hrs, 7 days, and 1-3 months afterward. Standard deviation scores of these variables (sd scores) were calculated to correct for age-related differences. To assess disease severity, the Pediatric Risk of Mortality (PRISM) score, the Sepsis-related Organ Failure Assessment (SOFA) score, and the Disseminated Intravascular Coagulation (DIC) score were determined as well as selected laboratory variables. MEASUREMENTS AND MAIN RESULTS:Ten patients died. Total serum cholesterol on admission was very low in all patients. This hypocholesterolemia was caused by low HDL concentrations but in particular by low LDL cholesterol levels. Eight patients had undetectable LDL levels on admission. Total cholesterol levels were significantly lower in nonsurvivors than in survivors (0.97 vs. 1.60, p = .013), whereas levels of LDL and HDL did not significantly differ between both groups. Total cholesterol sd scores were similar between survivors and nonsurvivors. Within survivors, cholesterol sd score was significantly lower in patients with shock compared with those with sepsis. The total cholesterol, HDL, and LDL levels correlated with clinical variables of disease severity and with levels of cytokines. Total cholesterol, HDL, and LDL levels normalized rapidly in survivors and were completely normal 1-3 months after admission. CONCLUSIONS:Extremely low levels of total serum cholesterol, HDL, and LDL are found in the initial phase of children with severe meningococcal disease. Total cholesterol levels are significantly lower in nonsurvivors than in survivors, but not the sd score. Total cholesterol, HDL, and LDL levels on admission are inversely associated with disease severity. Hypocholesterolism is associated with hypocortisolism. The concentrations of total cholesterol and lipoproteins steadily increase after 24 hrs in survivors and are normalized 1-3 months after pediatric intensive care unit admission.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Vermont CL,den Brinker M,Kâkeci N,de Kleijn ED,de Rijke YB,Joosten KF,de Groot R,Hazelzet JA

doi

10.1097/01.ccm.0000171272.50888.ad

subject

Has Abstract

pub_date

2005-07-01 00:00:00

pages

1610-5

issue

eissn

0090-3493

issn

1530-0293

pii

00003246-200507000-00020

journal_volume

pub_type

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Serum lipids and disease severity in children with severe meningococcal sepsis.