STUDY OF SERUM HDL-CHOLESTEROL LEVELS IN SEPSIS PATIENTS AND ITS PROGNOSTIC SIGNIFICANCE

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INVESTIGATOR DR.– BHARGAV KIRAN GADDAMREG. NO: 1601091001

MD, GENERAL MEDICINE, MGMCRI.

GUIDE : DR. M.NARAYANAN PROFESSOR DEPARTMENT OF GENERAL MEDICINE , MGMC & RI

CO-GUIDE DR. E.DEYAGARASANASSISTANT PROFESSORDEPARTMENT OF GENERAL MEDICINE , MGMC & RI

INTRODUCTION• Sepsis is defined as the presence (probable or documented) of infection together with systemic

manifestations

• It is the second leading cause of mortality in the ICU after multi-organ failure.• Given that the reversibility of severe sepsis is poor, the need for an “Early Prognostic Marker” to

identify those at highest risk for mortality in order to optimize therapeutic options is critical there by to reduce the ICU mortality secondary to sepsis.• Recent evidence shows that serum High density lipoprotein cholesterol (HDL-C) may be a

useful prognostic marker of sepsis .• Additional studies have demonstrated that patients diagnosed with severe sepsis in the ICU

have a measured decrease in circulating level of lipoproteins and an increase in triglycerides independent of comorbidities.

REVIEW OF LITERATURE

Naresh Monigari et al ( July 2015 : Manipal)(1) concluded that there is significant association of low HDL value on day 1 with mortality.

Risk of death in patients with day 1 HDL value <10mg/dl is 7.01 times the risk of death in patients with day 1 HDL value ≥10mg/dl .

Trend of HDL correlated with clinical outcome of patients. Raising trend favors improvement in clinical condition and decreasing trend implied worsening of the clinical condition.

SH Lee et al (2015) (3) concluded from his study that Non-survivors showed significantly higher SOFA scores than survivors .Non-survivors had low levels of HDL, on days 0, 1, 3, and 7.

Shor R et al (2008) retrospective analysis of 204 patients showed low HDL (≤20 mg/dl) was associated with a 17.5-fold increase in odds for death compared to HDL ≥ 65 mg/dl

AIMS AND OBJECTIVES

• Aim: To evaluate the correlation between septicemia and high density Lipoproteins–Cholesterol (HDL-C-) level in Sepsis patients. To further correlate with prognostic outcome of patients with abnormal HDL-C levels.

• Objectives:• To measure HDL-C values in all patients in sepsis.• To assess and compare the prognosis and response to treatment

in correlation with values of HDL-C.

INCLUSION CRITERIAPatients with age greater than 18 years and satisfying the criteria

for Sepsis.

EXCLUSION CRITERIA• Patients on treatment with statins• Patients with Chronic liver disease, chronic kidney disease, thyroid

dysfunction, diabetes.• Patients with known chronic inflammatory conditions like Human

immunodeficiency virus disease, SLE (Systemic lupus erythematous) and RA (Rheumatoid arthritis)• Patients diagnosed to have malabsorption disorders.

METHODOLOGY• This study is being conducted in MGMC&RI. • The study period is from November 2016 to march 2018.• Those patients diagnosed to be in Sepsis will be the study participants. • Whenever patient is diagnosed to be in sepsis, those patients will be contacted

immediately. • Details of the study will be explained in detail. Permission is sought in the form of

written consent and the study is conducted.• After ethical committee approval all the patients diagnosed to have sepsis in High

dependency units/wards of Mahatma Gandhi Medical College and research institute will be recruited for the study. • Blood samples from each patient will be taken for HDL-C-cholesterol levels,

creatinine, bilirubin levels, and platelet levels at the time of admission and on the day 5 after admission and SOFA scores will be calculated accordingly on day of admission and day 5 and assessed accordingly.

SAMPLE SIZE: After going through the past records I selected the number of patients to be included in the study would be 100.

STUDY GROUPS: Number of groups: ONETYPE OF STUDY:

Hospital based observation-cross sectional study.

STATISTICS: Study Variables :

ETHICAL ISSUESPatient will be included in the study after getting Informed consent.All the investigations and management For vulnerable patients are done according to existing guidelines and for Re-stratification the Prognosis of the patient HDL-C levels are Estimated and assessed routinely in treatment (which are availed not at the expense of patients.)

SERIAL NO : STUDY VARIABLE MEASUREMENT STATISTICS

1 AGE QUANTITATIVE MEAN / SD

2 GENDER QUALITATIVE PERCENTAGE

3 LENGTH OF ICU STAY (DAYS) QUANTITATIVE MEAN / SD

4 HDL-C LEVELS QUANTITATIVE MEAN / SD

5 SOFA SCORE QUANTITATIVE MEAN / SD

6 LIVER FUNCTION TESTS QUANTITATIVE MEAN /SD

7 BLOOD SUGAR LEVELS QUANTITATIVE MEAN / SD

8 CREATININE LEVELS QUANTITATIVE MEAN/ SD

9 PLATELET LEVELS QUANTITATIVE MEAN / SD

10 PAO2/FI02 (MMHG) QUANTITATIVE MEAN / SD

11 GLASGOW COMA SCALE QUANTITATIVE MEAN / SD

12 MEAN ARTERIAL PRESSURE QUANTITATIVE MEAN/ SD

13 CRP QUANTITATIVE MEAN / SD

REFERENCES[1] Naresh Monigari. Study of Serum HDL Levels in Severe Sepsis Patients in Medical Intensive Care Unit. International Journal of Scientific and Research Publications, Volume 5, Issue 7, July 2015 (2) Thomas, Whitney, "Serum cholesterol: A Superior Prognostic Marker of Sepsis Mortality in the ICU Compared to Procalcitonin or Creactive Protein" (2015). School of Physician Assistant Studies. Paper528

(3) Lee et al. Intensive Care Medicine Experimental 2015, 3(Suppl 1):A226(4) Todi S, Chatterjee S, Sahu S, Bhattacharyya M. Epidemiology of severe sepsis in India: an update. Critical Care. 2010;14 (Suppl 1):P382 [5] Herzum I, Renz H. Inflammatory markers in SIRS, sepsis and septic shock. Curr Med Chem. 2008;15:581-587.