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- Title
Association Between Low-Density Lipoprotein Cholesterol Levels and Risk for Sepsis Among Patients Admitted to the Hospital With Infection.
- Authors
Feng, QiPing; Wei, Wei-Qi; Chaugai, Sandip; Leon, Barbara G. Carranza; Mosley, Jonathan D.; Leon, Daniel A. Carranza; Jiang, Lan; Ihegword, Andrea; Shaffer, Christian M.; Linton, MacRae F.; Chung, Cecilia P.; Stein, C. Michael
- Abstract
Key Points: Question: What is the association between low levels of low-density lipoprotein cholesterol and risk of sepsis in patients admitted to the hospital with serious infection? Findings: In this cohort study of deidentified electronic medical records of patients admitted to the hospital with infection, measured levels of low-density lipoprotein cholesterol in 3961 patients and a low-density lipoprotein cholesterol genetic risk score in 7804 patients were not associated with increased risk of sepsis after adjusting for comorbidities. Meaning: Levels of low-density lipoprotein cholesterol are not directly associated with the risk of sepsis or poor outcomes in patients hospitalized with infection. This cohort study of medical records assesses whether low-density lipoprotein cholesterol (LDL-C) levels are associated with an increased risk of sepsis among patients admitted to the hospital with infection. Importance: Whether low levels of low-density lipoprotein cholesterol (LDL-C) are associated with increased risk of sepsis and poorer outcomes is unknown. Objective: To examine the association between LDL-C levels and risk of sepsis among patients admitted to the hospital with infection. Design, Setting, and Participants: Cohort study in which deidentified electronic health records were used to define a cohort of patients admitted to Vanderbilt University Medical Center, Nashville, Tennessee, with infection. Patients were white adults, had a code indicating infection from the International Classification of Diseases, Ninth Revision, Clinical Modification, and received an antibiotic within 1 day of hospital admission (N = 61 502). Data were collected from January 1, 1993, through December 31, 2017, and analyzed from January 24 through October 31, 2018. Interventions: Clinically measured LDL-C levels (excluding measurements <1 year before hospital admission and those associated with acute illness) and a genetic risk score (GRS). Main Outcomes and Measures: The primary outcome was sepsis; secondary outcomes included admission to an intensive care unit (ICU) and in-hospital death. Results: Among the 3961 patients with clinically measured LDL-C levels (57.8% women; mean [SD] age, 64.1 [15.9] years) and the 7804 with a GRS for LDL-C (54.0% men; mean [SD] age, 59.8 [15.2] years), lower measured LDL-C levels were significantly associated with increased risk of sepsis (odds ratio [OR], 0.86; 95% CI, 0.79-0.94; P =.001) and ICU admission (OR, 0.85; 95% CI, 0.76-0.96; P =.008), but not in-hospital mortality (OR, 0.80; 95% CI, 0.63-1.00; P =.06); however, none of these associations were statistically significant after adjustment for age, sex, and comorbidity variables (OR for risk of sepsis, 0.96 [95% CI, 0.88-1.06]; OR for ICU admission, 0.94 [95% CI, 0.83-1.06]; OR for in-hospital death, 0.97 [95% CI, 0.76-1.22]; P >.05 for all). The LDL-C GRS correlated with measured LDL-C levels (r = 0.24; P < 2.2 × 10−16) but was not significantly associated with any of the outcomes. Conclusions and Relevance: Results of this study suggest that lower measured LDL-C levels were significantly associated with increased risk of sepsis and admission to ICU in patients admitted to the hospital with infection; however, this association was due to comorbidities because both clinical models adjusted for confounders, and the genetic model showed no increased risk. Levels of LDL-C do not appear to directly alter the risk of sepsis or poor outcomes in patients hospitalized with infection.
- Subjects
TENNESSEE; SEPSIS; CONFIDENCE intervals; HOSPITAL care; INFECTION; LONGITUDINAL method; LOW density lipoproteins; RESEARCH funding; COMORBIDITY; LOGISTIC regression analysis; TREATMENT effectiveness; DESCRIPTIVE statistics; ODDS ratio; DISEASE risk factors
- Publication
JAMA Network Open, 2019, Vol 2, Issue 1, pe187223
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2018.7223