Impaired High-Density Lipoprotein Anti-Oxidant Function Predicts Poor Outcome in Critically Ill Patients

• Published in: PloS one Vol. 11; no. 3; p. e0151706
• Main Authors: Schrutka, Lore, Goliasch, Georg, Meyer, Brigitte, Wurm, Raphael, Koller, Lorenz, Kriechbaumer, Lukas, Heinz, Gottfried, Pacher, Richard, Lang, Irene M, Distelmaier, Klaus, Hülsmann, Martin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 15.03.2016; Public Library of Science (PLoS)
• Subjects: Aged; Antioxidants (Nutrients); Antioxidants - metabolism; Apolipoproteins; Austria - epidemiology; Biology and Life Sciences; Cardiovascular disease; Cardiovascular Diseases - blood; Cause of Death; Correlation analysis; Critical Illness - mortality; Critically ill persons; Diagnosis-Related Groups; Female; Genetic aspects; Guardians; High density lipoprotein; High density lipoproteins; Hospitals, University - statistics & numerical data; Humans; Inflammation; Inflammation - metabolism; Intensive care; Intensive Care Units - statistics & numerical data; Internal medicine; Kaplan-Meier Estimate; Laboratories; Lipoproteins; Lipoproteins, HDL - blood; Lipoproteins, HDL - physiology; Male; Medical prognosis; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Oxidative Stress; Patients; Physiological aspects; Population studies; Prognosis; Proportional Hazards Models; Prospective Studies; Regression analysis; Rodents; Superoxide dismutase; Surgery; Treatment Outcome; Zinc; Austria
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0151706

Oxidative stress affects clinical outcome in critically ill patients. Although high-density lipoprotein (HDL) particles generally possess anti-oxidant capacities, deleterious properties of HDL have been described in acutely ill patients. The impact of anti-oxidant HDL capacities on clinical outcome in critically ill patients is unknown. We therefore analyzed the predictive value of anti-oxidant HDL function on mortality in an unselected cohort of critically ill patients. We prospectively enrolled 270 consecutive patients admitted to a university-affiliated intensive care unit (ICU) and determined anti-oxidant HDL function using the HDL oxidant index (HOI). Based on their HOI, the study population was stratified into patients with impaired anti-oxidant HDL function and the residual study population. During a median follow-up time of 9.8 years (IQR: 9.2 to 10.0), 69% of patients died. Cox regression analysis revealed a significant and independent association between impaired anti-oxidant HDL function and short-term mortality with an adjusted HR of 1.65 (95% CI 1.22-2.24; p = 0.001) as well as 10-year mortality with an adj. HR of 1.19 (95% CI 1.02-1.40; p = 0.032) when compared to the residual study population. Anti-oxidant HDL function correlated with the amount of oxidative stress as determined by Cu/Zn superoxide dismutase (r = 0.38; p<0.001). Impaired anti-oxidant HDL function represents a strong and independent predictor of 30-day mortality as well as long-term mortality in critically ill patients.