Relationship between high-density lipoprotein cholesterol (HDL-C) concentration and ventilator-associated pneumonia in ICU COVID-19 patients.

IF 3.7 3区医学 Q1 ANESTHESIOLOGY

Anaesthesia Critical Care & Pain Medicine Pub Date : 2025-05-01 DOI:10.1016/j.accpm.2025.101535

Stefan Andrei, Meilhac Olivier, Christian De Tymowski, Aurélie Snauwaert, Jules Stern, Tiphaine Robert, Brice Lortat-Jacob, Enora Atchade, Elie Kantor, Floran Begue, Philippe Montravers, Sébastien Tanaka

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引用次数: 0

Abstract

Background: Ventilator-associated pneumonia (VAP) is frequent during severe COVID-19 infection, but diagnosis remains difficult. During bacterial sepsis and COVID-19, high-density lipoprotein cholesterol (HDL-C) concentration is decreased. Furthermore, HDL particles exerting in normal conditions endothelial-protective effects are dysfunctional in bacterial sepsis. The lipidic profile in COVID-19 with associated bacterial infections is unexplored. The aim of the present study was to determine the relationship between HDL-C concentration on admission to the intensive care unit (ICU) for COVID-19 and the occurrence of VAP.

Methods: French prospective study (LIPICOR study) recording HDL-C concentration during severe COVID-19 in ICU. VAP episodes were reported prospectively.

Results: 122 patients were consecutively included in the analysis between October 2020 and May 2021. A total of 32 patients (26%) developed at least one VAP episode during the ICU stay. The median delay of VAP occurrence was 7 [3,10] days. Upon ICU admission, the median HDL-C concentration was 0.80 [0.65, 1.03] mmol/L. HDL-C was significantly higher in patients who secondarily developed VAP (HDL-C: 0.93 mmol/L [0.79, 1.12] vs. 0.77 mmol/L [0.63, 0.99], p = 0.003). Surprisingly, multivariable analyses with VAP showed that HDL-C at admission is associated with the occurrence of VAP (HR = 3.91 (1.45-10.5), p = 0.007). VAP occurrence in patients with HDL-C levels above 0.8 mmol/L at admission was higher (log-rank test, p = 0.003).

Conclusion: Increased HDL-C concentration on admission is strongly associated with the occurrence of VAP during severe COVID-19 infection.

Registration: ClinicalTrials.gov Identifier: NCT05113836.

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高密度脂蛋白胆固醇（HDL-C）浓度与ICU COVID-19患者呼吸机相关性肺炎的关系

背景：呼吸机相关性肺炎（VAP）在COVID-19重症感染中很常见，但诊断仍然很困难。在细菌性败血症和COVID-19期间，高密度脂蛋白胆固醇（HDL-C）浓度降低。此外，在正常情况下发挥内皮保护作用的HDL颗粒在细菌性败血症中功能失调。COVID-19与相关细菌感染的脂质谱尚未研究。本研究的目的是确定COVID-19患者入住重症监护病房（ICU）时HDL-C浓度与VAP发生之间的关系。方法：法国前瞻性研究（LIPICOR研究）记录重症COVID-19 ICU患者的HDL-C浓度。前瞻性地报道VAP发作。结果：122例患者于2020年10月至2021年5月连续纳入分析。共有32例患者（26%）在ICU住院期间出现至少一次VAP发作。VAP发生的中位延迟时间为7[3,10]天。入院时，中位HDL-C浓度为0.80 [0.65,1.03]mmol/L。继发性VAP患者的HDL-C明显升高（HDL-C: 0.93 mmol/L [0.79, 1.12] vs. 0.77 mmol/L [0.63, 0.99], p = 0.003）。令人惊讶的是，VAP的多变量分析显示，入院时HDL-C与VAP的发生有关（HR = 3.91 (1.45-10.5), p = 0.007）。入院时HDL-C水平高于0.8 mmol/L的患者VAP发生率较高（log-rank检验，p = 0.003）。结论：入院时HDL-C浓度升高与重症COVID-19感染时VAP的发生密切相关。注册：ClinicalTrials.gov标识符：NCT05113836。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Anaesthesia Critical Care & Pain Medicine ANESTHESIOLOGY-

CiteScore

6.70

自引率

5.50%

发文量

150

审稿时长

18 days

期刊介绍： Anaesthesia, Critical Care & Pain Medicine (formerly Annales Françaises d''Anesthésie et de Réanimation) publishes in English the highest quality original material, both scientific and clinical, on all aspects of anaesthesia, critical care & pain medicine.