Replication Data for: Alterations in the lipid profile of critically ill children in relation to outcome. Lauren De Bruyn et al. Crit Care 2025. doi.org/10.1186/s13054-025-05327-5

Background: Critically ill adults typically develop hypocholesterolemia, associated with poor outcome. Whether similar alterations occur in critically ill children is less clear. Methods: In secondary analyses of the PEPaNIC RCT (n = 1440), we first documented the time course of plasma cholesterol and triglyceride concentrations, and the effect of randomization to early-parenteral-nutrition (early-PN) or late-PN hereon, for 96 matched critically ill children staying ≥ 5 days in PICU. Second, for 1165 children with available admission plasma samples, lipid profiles were determined and their independent associations with outcome (time to live PICU discharge, new infection and 90-day mortality) were assessed with Multivariable Cox proportional hazard and logistic regression, adjusting for baseline risk factors. Results: Plasma HDL-cholesterol, LDL-cholesterol, total-cholesterol and triglycerides were low throughout the 5 PICU days, with only HDL-cholesterol further decreasing over time (P < 0.0001) and without effect of randomization to early-PN or late-PN, and with admission values lower in infants than older children and in patients with infection (P < 0.05). Lower admission HDL- and total-cholesterol concentrations were independently associated with a lower likelihood of an earlier live PICU discharge (P < 0.001) and with a higher risk of 90-day mortality (P ≤ 0.01), whereas higher plasma triglycerides were independently associated with higher risk of 90-day mortality (P = 0.004). Low admission plasma HDL-cholesterol was independently associated with a higher risk of acquiring a new infection (P = 0.05). Conclusion: Critically ill children presented with low circulating levels of lipids. Low plasma cholesterol concentrations were associated with poor outcomes, most robustly for HDL-cholesterol. Whether these associations are causal or casual requires further investigation.

背景：危重症成人通常会发生低胆固醇血症（hypocholesterolemia），且与不良预后相关。但危重症儿童是否存在类似的血脂改变尚不清楚。

方法：在PEPaNIC随机对照试验（RCT，n=1440）的二次分析中，我们首先记录了96例匹配的、在儿科重症监护室（PICU）停留≥5天的危重症儿童的血浆胆固醇和甘油三酯浓度的时间变化趋势，以及随机分配至早期肠外营养（early-parenteral-nutrition，early-PN）或晚期肠外营养（late-PN）对其的影响。其次，对1165例入院时可获得血浆样本的儿童测定其血脂谱，并通过多变量Cox比例风险模型和逻辑回归分析，在调整基线风险因素后，评估血脂谱与预后（存活出院至PICU的时间、新发感染及90天死亡率）的独立关联。

结果：在PICU停留的5天内，血浆高密度脂蛋白胆固醇（HDL-cholesterol）、低密度脂蛋白胆固醇（LDL-cholesterol）、总胆固醇及甘油三酯水平均处于较低状态；其中仅HDL-cholesterol随时间进一步降低（P<0.0001），且早期-PN或晚期-PN的随机分配对此无显著影响。此外，婴儿入院时的血脂水平低于年长儿童，感染患者的入院血脂水平也更低（P<0.05）。入院时HDL-cholesterol和总胆固醇水平较低与早期存活出院至PICU的可能性降低及90天死亡率升高独立相关（P<0.001及P≤0.01）；而血浆甘油三酯水平较高与90天死亡率升高独立相关（P=0.004）。入院时血浆HDL-cholesterol水平较低还与新发感染风险升高独立相关（P=0.05）。

结论：危重症儿童存在循环血脂水平降低的情况。血浆胆固醇水平降低与不良预后相关，其中HDL-cholesterol的相关性最为显著。这些关联是因果关系还是偶然关联尚需进一步研究。