• Faheem W Guirgis, Sunita Dodani, Lyle Moldawer, Christiaan Leeuwenburgh, Jennifer Bowman, Colleen Kalynych, Alan E Jones, Srinivasa T Reddy, and Frederick A Moore.
• *Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida †Department of Family and Community Medicine, College of Medicine, Mayo Clinic, Jacksonville, Florida ‡Department of Surgery, University of Florida College of Medicine, Gainesville, Florida §Department of Aging and Geriatrics, University of Florida College of Medicine, Gainesville, Florida ||Department of Emergency Medicine, University of Mississippi College of Medicine, Jackson, Mississippi ¶Department of Medicine, Molecular, and Medical Pharmacology, UCLA School of Medicine, Los Angeles, California.
• Shock. 2017 Nov 1; 48 (5): 539544539-544.

BackgroundHigh density lipoprotein (HDL) can be readily oxidized in inflammatory conditions and exhibit pro-inflammatory and dysfunctional (Dys-HDL) characteristics. We hypothesize that Dys-HDL may predict adverse outcomes and correlate with inflammatory cytokines in sepsis.MethodsEmergency department (ED) patients with sepsis were enrolled. Blood was drawn at enrollment and after 48 h. Dys-HDL, expressed as HDL inflammatory index (HII), and cytokines were measured. Multivariable logistic regression was used to determine the predictive ability of Dys-HDL for adverse outcomes (death, discharge to hospice, or nursing home).ResultsThirty-five patients were included in the study. HII was not significantly different at baseline or 48 h between patients with adverse outcomes versus those without. However, there was a significant difference in change in HII over the first 48 h between those with adverse outcomes (+0.21, 95% CI -0.13 to 0.31) versus those without (-0.11, 95% CI -1 to 0.11) (P = 0.025). Logistic regression revealed increasing HII to be an independent predictor of adverse outcomes (OR 5.2, 95% CI 1.1-25.1 P = 0.040). Of the 24 patents with cytokine measurements at both time points, significant inverse correlations between change in HII and change in GRO (rs = -0.52, P = 0.0088) and monocyte chemotactic protein-1 (rs = -0.61, P = 0.0014) concentrations over 48 h were observed.ConclusionIncreasing Dys-HDL concentrations in the first 48 h of sepsis are associated with an ongoing inflammatory response and adverse clinical outcomes. Early changes in HII may be a potential biomarker in ED patients admitted with sepsis.

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