Long-Term Effects of Critical Care Insults on Lipoprotein Metabolism

Abstract

Background: Several reports demonstrated acute changes in lipoprotein profiles during the acute phase of critical care illness (CCI), with significantly fewer investigations suggesting the persistence of lipid abnormalities past 28 days from onset of CCI, or into recovery. Theoretically, their persistence into a recovery of CCI may profoundly impact health as dyslipidemias are considered critically important in the natural history of atherosclerosis. Considering the increased incidence of survivorship after CCI (sepsis, trauma, severe surgery, burn), and the profound effect of even small changes in lipid makeup over time, investigating the persistence of lipid profile abnormalities addresses important health concerns. Here, we conducted a comprehensive review focusing on long-term (28 days or greater) lipoprotein abnormalities after CCI onset. Methods: The supervised, narrative literature review utilized the PubMed, EBSCO, and Google Scholar databases using keywords (sepsis, trauma, surgery, stroke, recovery). In addition, we pursued studies focusing on 28 days observation periods, at minimum, after the resolution of acute inflammation. We identified 26 studies fitting our criteria, with another 11 included because of their input value. Results: Only a handful of studies investigated long-term lipid profiles after sepsis, trauma, surgery, or traumatic brain injury. Persistent depression of HDL-c and LDL-c serum levels were the hallmarks of several post-CCI conditions. Furthermore, few investigators reported an increase in the oxidation of LDL. One animal study linked these observations to acceleration in the atherosclerotic process in animals surviving weeks after sepsis resolution. Conclusions: Scant data indicates that recovery from critical care illness is associated with several persistent lipoprotein abnormalities. Numerous gaps in knowledge persist, particularly in terms of the clinical translation of observed lipid abnormalities into long-term cardiovascular outcomes post-CCI.