Propofol and Hypertriglyceridemia in the ICU: A Systematic Review and Meta-Analysis of Recent Observational Data

While previous expert consensus guidelines by the American College of Critical Medicine recommend serum triglyceride monitoring after two consecutive days of propofol, the most recent Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption guidelines do not address monitoring triglyceride levels in patients on continuous propofol infusions. Recent cohort studies have shown that a majority of patients on continuous propofol lack triglyceride measurements. Our objective was to systematically summarize and compare the reported incidence of pancreatitis, hospital length of stay (LOS), intensive care unit (ICU) LOS, and hospital mortality in patients on continuous propofol infusions who developed hypertriglyceridemia (HTG) compared with those without HTG. Methods included Medical Subject Headings terms and keywords were used to construct a systematic search according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines involving PubMed, Embase, Web of Science, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Inclusion criteria were papers published in English, since 2000, involving ICU patients ≥18 years old, who were on continuous propofol infusions. Six of the 790 studies identified (2,301 patients) were included. Pooled incidence of HTG was 28% with an average onset of 4.3 days. Both ICU LOS (pooled standardized mean difference (SMD) = 0.37, 95% CI: (0.16, 0.58), p < 0.0001, I² = 47%) and hospital LOS (pooled SMD = 0.21, 95% CI: (0.06, 0.35), p < 0.0001, I² = 0%) were increased in patients who developed HTG. Pooled incidence of pancreatitis was 1.3% with no significant difference between groups. In conclusion, HTG in ICU patients requiring continuous propofol infusions was associated with increased ICU and hospital LOS, with no significant differences in pancreatitis incidence or mortality. While this does not demonstrate causality due to its retrospective nature, it does point to an association of worse outcomes and hypertriglyceridemia in this setting.