VARIATION IN PLASMA-LIPID AND LIPOPROTEIN CONCENTRATIONS IN COMMUNITY-ACQUIRED PNEUMONIA - A 6-MONTH PROSPECTIVE-STUDY

The nature of changes in the lipid profile caused by an acute infectio n is controversial. The aims of the present study were to study the ch anges in plasma lipids and lipoproteins in community-acquired pneumoni a, to determine whether these changes differ according to the aetiolog ica/agents, and finally to observe the behaviour of these lipoproteins six months later. Sixty patients, aged between 18 and 87 years, admit ted during the period September 1992 and April 1993 with suspected com munity-acquired pneumonia, were included in the study. Fifty-three of the patients completed the 15-day follow-up investigation, and 37 rema ined available for study for up to 6 months. On admission and at 15 an d 180 days, analyses were carried out for total cholesterol, HDL chole sterol, apolipoproteins A(1) and B, triacylglycerols and transaminases . Student's t test for parametric variables was used for statistical a nalysis, and the Mann-Whitney test for non-parametric variables. The c oncentrations of total cholesterol (4.2 +/- 1.0 vs 5.5 +/- 1.3 mmol/l) , HDL cholesterol (0.9 +/- 0.4 vs 1.2 +/- 0.3 mmol/l), apolipoprotein A(1) (0.80 +/- 0.25 vs 1.15 +/- 0.28 g/l and apolipoprotein B (0.77 +/ - 0.28 vs 0.95 +/- 0.28 g/l showed significantly lower values during t he acute infectious process. These analyte concentrations became stabl e after 15 days with the exception of HDL cholesterol which continued to increase until 6 months (1.2 +/- 0.3 vs 1.3 +/- 0.3 mmol/l, p < 0.0 1). Patients with non-viral atypical pneumonia showed, on admission, h igher triacylglycerol values (1.8 +/- 0.8 vs 1.3 +/- 0.9 mmol/l, p < 0 .01) and lower HDL cholesterol values (0.6 +/- 0.3 vs 1.0 +/- 0.4 mmol /l, p < 0.03). Values of aspartate aminotransferase (112 +/- 117 vs 23 +/- 11 U/l, p < 0.001), alanine aminotransferase (127 +/- 141 vs 24 /- 16 U/l; p < 0.02) and gamma-glutamyl transferase (113 +/- 158 vs 33 +/- 25 U/l, p < 0.03) were higher in the subgroup of non-viral atypic al pneumonia. In conclusion, patients with community-acquired pneumoni a present a significant decline in total cholesterol, HDL cholesterol and apolipoprotein A(1) and B concentrations. Lower concentrations of HDL cholesterol are maintained up 15 days. Patients with non-viral aty pical pneumonia present on admission significantly higher triacylglyce rol and lower HDL cholesterol values. Those with non-viral atypical pn eumonia also present higher transaminase values.