The prognostic utility of HDL as a biomarker for sepsis or septic shock: A systematic review and meta-analysis

BACKGROUND: We systematically reviewed and meta-analyzed prospective observational evidence on the association between circulating high-density lipoprotein (HDL) levels and short-term mortality in adult patients with sepsis or septic shock. METHODS: The databases of PubMed, EMBASE, Cochrane Library, CBM, CNKI, Wanfang and VIP were searched for all the studies. RevMan5.4 was used to analyze the sensitivity and heterogeneity and then calculate the combined effect. Funnel plots were applied to evaluate the publication bias of the included studies. RESULTS: A total of 9 studies were included and synthesized in the analysis. 867 patients were divided into the survival group (n = 562) and the death group (n = 305). The results showed that the HDL levels increased in sepsis survivors compared to non-survivors (standardized mean difference = 4.67, 95% confidence interval = 1.01-8.34, Z = 2.50, P = .01, I2 = 52%). There were higher levels of low-density lipoprotein (LDL) and cholesterol among patients in the survival group than among those in the death group. The triglycerides levels had no significant difference between the 2 groups. Sensitivity analysis indicated that the results were stable. The funnel plot showed that the effect points of the 9 studies were roughly in the form of "inverted funnels." CONCLUSION: Lower HDL levels measured early in sepsis are associated with higher short-term mortality, but the current evidence is observational and of low certainty. HDL may be useful as an adjunctive risk stratification marker rather than a stand-alone decision tool, and its therapeutic relevance requires prospective validation.