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Pathogenic lipids (e.g. lipopolysaccharide) are removed from the circulation by an <jats:styled-content style=\"fixed-case\">LDLR<\/jats:styled-content>\/<jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9\u2010dependent mechanism; thus, it has been suggested that <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 inhibitors may be beneficial in the treatment of infections. We measured plasma <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 levels in patients with culture\u2010positive bacteraemia and explored pathogen\u2010dependent and infection site\u2010dependent effects as well as correlations between patient characteristics and outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Proprotein convertase subtilisin\/kexin type 9 in the plasma was measured with an enzyme\u2010linked immunosorbent assay from 481 patients with blood culture\u2010positive infection on days 0 to 4 after admission to the emergency department. Patient outcome and clinical and laboratory data were gathered retrospectively from patient records.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The plasma <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 level was elevated equally in patients with Gram\u2010positive or Gram\u2010negative bacterial infections; particularly high levels were seen in patients with a lower respiratory tract infection and <jats:italic>Streptococcus pneumoniae<\/jats:italic> bacteraemia. <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 levels showed a significant positive correlation with C\u2010reactive protein (<jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content>) level. Bacteraemia patients with liver disease or a history of alcohol abuse had significantly lower levels of plasma <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9. Reduced <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 plasma responses in patients were significantly associated with mortality at days 7, 28 and 90.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Proprotein convertase subtilisin\/kexin type 9 is upregulated in blood culture\u2010positive infections. Plasma <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 resembles acute\u2010phase proteins; its expression is induced during an infection, reduced in liver disease and correlates positively with <jats:styled-content style=\"fixed-case\">CRP<\/jats:styled-content> level. We have shown that <jats:styled-content style=\"fixed-case\">PCSK<\/jats:styled-content>9 levels are lower in patients with a fatal prognosis.<\/jats:p><\/jats:sec>","DOI":"10.1111\/joim.12946","type":"journal-article","created":{"date-parts":[[2019,6,5]],"date-time":"2019-06-05T12:53:51Z","timestamp":1559739231000},"page":"553-561","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":44,"title":["Reduced plasma <scp>PCSK<\/scp>9 response in patients with bacteraemia is associated with mortality"],"prefix":"10.1111","volume":"286","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7199-6306","authenticated-orcid":false,"given":"J.","family":"Rannikko","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Tampere University Hospital Tampere Finland"},{"name":"Faculty of Medicine and Health Technology Tampere University Tampere 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