STROBE-MR checklist.

Background
Sepsis is a severe systemic infection that can result in organ dysfunction and mortality. Dyslipidemia emerges as a key player in the intricate web of sepsis pathogenesis. Yet, the causal relationship between blood lipid profiles and sepsis risk remains uncertain. This study aims to investigate the association between genetically predicted lipid traits, drug targets, and sepsis.
Methods
The UK Biobank’s Genome-wide association studies (GWAS) produced data on lipid and apolipoprotein characteristics. Four independent GWAS datasets were used to generate the sepsis statistics. The study utilized the two-sample Mendelian randomization (MR) approach, which incorporates multivariable (MVMR) models, to assess the correlations between sepsis risk and lipid-related parameters. To gain further insight, expression quantitative trait loci (eQTL) data were used to investigate the significant drug targets for lipid-lowering.
Results
Increasing ApoA-1 levels was associated with a diminished risk of sepsis (under 75) (OR 0.927, 95% CI 0.861–0.999; p = 0.047). This inverse correlation persevered even after performing multivariable MR. Elevated levels of HDL-C were associated with a decreased risk of sepsis (under 75) (OR 0.897, 95% CI 0.838–0.960; P = 0.002) and incidence of sepsis (OR 0.883, 95% CI 0.820–0.951; P = 0.001), which was consistent across sensitivity analyses. Furthermore, a decrease in total cholesterol exhibited a causal effect on sepsis in multivariable MR (OR 0.779, 95% CI 0.642–0.944; P = 0.01). The genetic variants related to lowering LDL-C, located near the HMGCR and LDLR genes, were predicted to elevate the risk of sepsis. Moreover, genetic mimicry near the ANGPTL3 and LPL gene suggested that reducing the activity of ANGPTL3 and LPL (mimicking antisense anti-ANGPTL3 and LPL agents) was forecasted to decrease sepsis risk.
Conclusion
Genetically inferred elevated ApoA-1, total cholesterol, and HDL-C manifest a protective effect against sepsis. Within the 9 lipid-lowering drug targets investigated ANGPTL3 and LPL exhibit potential as candidate drug targets for sepsis.