Intensive Care Med (2008) 34:907–911 DOI 10.1007/s00134-008-1006-y BRIEF REPORT Jimmy F. P. Berbée Caroline C. van der Hoogt Carla J. C. de Haas Kok P. M. van Kessel Geesje M. Dallinga-Thie Johannes A. Romijn Louis M. Havekes Henk J. van Leeuwen Patrick C. N. Rensen Plasma apolipoprotein CI correlates with increased survival in patients with severe sepsis Received: 31 August 2007 Accepted: 22 December 2007 Published online: 30 January 2008 © Springer-Verlag 2008 Electronic supplementary material The online version of this article (doi:10.1007/s00134-008-1006-y) contains supplementary material, which is available to authorized users. J. F.P. Berbée (✉) · C. C. van der Hoogt · J. A. Romijn · L. M. Havekes · P. C. N. Rensen Leiden University Medical Center, C4-R, Department of General Internal Medicine, Endocrinology and Metabolic Diseases, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands e-mail: J.F.P.Berbee@lumc.nl J. F.P. Berbée · C. C. van der Hoogt · L. M. Havekes · P.C. N. Rensen Gaubius Laboratory, Department of Biomedical Research, TNO-Quality of Life, P.O. Box 2215, 2301 CE Leiden, The Netherlands C. J. C. de Haas · K. P.M. van Kessel · H. J. van Leeuwen University Medical Center Utrecht, Department of Inflammation, Eijkman Winkler Institute for Medical Microbiology, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands G. M. Dallinga-Thie Amsterdam Medical Center, Department of Vascular Medicine, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands L. M. Havekes Leiden University Medical Center, Department of Cardiology, P.O. Box 9600, 2300 RC Leiden, The Netherlands Abstract Objective: We recently reported that apolipoprotein CI (apoCI) protects against the devel- opment of murine bacterial sepsis. We now examined the time course of plasma apoCI levels in survivors and non-survivors of severe sepsis. Design: Prospective study in patients meeting predefined criteria for severe sepsis. Setting: University hospital intensive care unit. Patients and participants: Seventeen patients with severe sepsis. Interventions: In each patient, serial blood samples for determination of total cholesterol, LDL-cholesterol, HDL-cholesterol, triglycerides, apoCI, apoAI, apoB, and apoCIII protein as well as clin- ical outcome data were collected over 30 days. Measurements and results: Upon hospitalization, apoCI levels were approximately 5 times lower than normal values in septic patients, i.e. median 1.34 [interquar- tile range (IQR) 0.82–2.16] mg/dl. ApoCI gradually increased to median values of 5.51 (IQR 3.64–6.97) mg/dl on day 28. At day 0, apoCI levels tended to be lower in non-survivors than in survivors. Remarkably, apoCI levels remained low in non-survivors, whereas apoCI levels gradually in- creased to normal levels in survivors. This difference was significant and remained so after adjustment for lipoprotein core lipids. No such effect between survivors and non-survivors could be detected for lipoprotein lipids or for apoAI, apoB, and apoCIII after lipid adjustment. Conclusions: Plasma apoCI levels are markedly de- creased in patients with severe sepsis. ApoCI levels were higher in sur- vivors, even after adjustment for lipid levels, and recovered progressively to normal levels. In contrast, apoCI levels remained low in non-survivors. Therefore, a high plasma apoCI level predicts survival in patients with severe sepsis. Keywords Apolipoprotein · Lipopro- tein · Bacteria · Sepsis · Mortality · Intensive care