{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:49:38Z","timestamp":1777376978162,"version":"3.51.4"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T00:00:00Z","timestamp":1701043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82202389"],"award-info":[{"award-number":["82202389"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81870441"],"award-info":[{"award-number":["81870441"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82070669"],"award-info":[{"award-number":["82070669"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Sepsis is characterized by upregulated lipolysis in adipose tissue and a high blood triglyceride (TG) level. It is still debated whether serum TG level is related to mortality in septic patients. The aim of this study is to investigate the association between serum TG level and mortality in septic patients admitted to the intensive care unit (ICU).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from adult septic patients (\u226518 years) admitted to the ICU for the first time were obtained from the Multiparameter Intelligent Monitoring in Intensive Care IV (MIMIC-IV) database. The patients\u2019 serum TG levels that were measured within the first week after ICU admission were extracted for statistical analysis. The endpoints were 28-day, ICU and in-hospital mortality.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>A total of 2,782 septic patients were included. Univariate analysis indicated that the relationship between serum TG levels and the risk of mortality was significantly nonlinear. Both the Lowess smoothing technique and restricted cubic spline analyses revealed a U-shaped association between serum TG levels and mortality among septic patients. The lowest mortality rate was associated with a serum TG level of 300\u2013500 mg\/dL. Using 300\u223c500 mg\/dL as the reference range, we found that both hypo-TG (<jats:bold>&lt;<\/jats:bold>300 mg\/dL) and hyper-TG (\u2265500 mg\/dL) were associated with increased mortality. The result was further adjusted by Cox regression with and without the inclusion of some differential covariates.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>There was a U-shaped association between serum TG and mortality in septic ICU patients. The optimal concentration of serum TG levels in septic ICU patients is 300\u2013500 mg\/dL.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0294779","type":"journal-article","created":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T18:45:37Z","timestamp":1701110737000},"page":"e0294779","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["U-shaped association between serum triglyceride levels and mortality among septic patients: An analysis based on the MIMIC-IV database"],"prefix":"10.1371","volume":"18","author":[{"given":"Min","family":"Xiao","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongbin","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjian","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxiu","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiemei","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Weiqin","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6175-3415","authenticated-orcid":true,"given":"Dadong","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,11,27]]},"reference":[{"issue":"3","key":"pone.0294779.ref001","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1007\/s00134-017-4683-6","article-title":"Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016","volume":"43","author":"A Rhodes","year":"2017","journal-title":"Intensive Care Med"},{"key":"pone.0294779.ref002","article-title":"Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021","author":"L Evans","year":"2021","journal-title":"Intensive Care Med"},{"issue":"8","key":"pone.0294779.ref003","doi-asserted-by":"crossref","first-page":"1552","DOI":"10.1007\/s00134-020-06151-x","article-title":"Incidence and mortality of hospital- and ICU-treated sepsis: results from an updated and expanded systematic review and meta-analysis","volume":"46","author":"C Fleischmann-Struzek","year":"2020","journal-title":"Intensive Care Med"},{"issue":"10219","key":"pone.0294779.ref004","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990\u20132017: analysis for the Global Burden of Disease Study","volume":"395","author":"KE Rudd","year":"2020","journal-title":"Lancet"},{"issue":"13","key":"pone.0294779.ref005","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1001\/jama.2017.13836","article-title":"Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009\u20132014","volume":"318","author":"C Rhee","year":"2017","journal-title":"JAMA"},{"issue":"3","key":"pone.0294779.ref006","doi-asserted-by":"crossref","first-page":"e209","DOI":"10.1097\/CCM.0000000000004155","article-title":"The Epidemiology of Sepsis in Chinese ICUs: A National Cross-Sectional Survey","volume":"48","author":"J Xie","year":"2020","journal-title":"Crit Care Med"},{"issue":"1\u20132","key":"pone.0294779.ref007","article-title":"Metabolic Resuscitation Therapy for Sepsis: Where to Go","volume":"1","author":"P Chang","year":"2021","journal-title":"Intensive Care Research"},{"issue":"2","key":"pone.0294779.ref008","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1089\/ars.2018.7537","article-title":"Metabolic Resuscitation Strategies to Prevent Organ Dysfunction in Sepsis","volume":"31","author":"VA Reitsema","year":"2019","journal-title":"Antioxid Redox Signal"},{"issue":"7","key":"pone.0294779.ref009","doi-asserted-by":"crossref","first-page":"E552","DOI":"10.21037\/jtd.2016.05.37","article-title":"Metabolic resuscitation in sepsis: a necessary step beyond the hemodynamic?","volume":"8","author":"HP Leite","year":"2016","journal-title":"J Thorac Dis"},{"key":"pone.0294779.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/j.jlr.2021.100090","article-title":"The lipid biology of sepsis","volume":"62","author":"K Amunugama","year":"2021","journal-title":"J Lipid Res"},{"key":"pone.0294779.ref011","first-page":"55","article-title":"Lipid profile associated with the systemic inflammatory response syndrome and sepsis in critically ill patients","author":"A Golucci","year":"2018","journal-title":"Nutrition"},{"issue":"11","key":"pone.0294779.ref012","doi-asserted-by":"crossref","DOI":"10.3390\/jcm10112412","article-title":"Metabolic Alterations in Sepsis","volume":"10","author":"W Wasyluk","year":"2021","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0294779.ref013","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13613-021-00800-0","article-title":"Relationship between lipoprotein concentrations and short-term and 1-year mortality in intensive care unit septic patients: results from the HIGHSEPS study","volume":"11","author":"S Tanaka","year":"2021","journal-title":"Ann Intensive Care"},{"issue":"1","key":"pone.0294779.ref014","doi-asserted-by":"crossref","DOI":"10.1186\/s13613-021-00865-x","article-title":"Lipid and lipoprotein predictors of functional outcomes and long-term mortality after surgical sepsis","volume":"11","author":"FW Guirgis","year":"2021","journal-title":"Annals of Intensive Care"},{"issue":"45","key":"pone.0294779.ref015","article-title":"Changes in plasma lipid and in-hospital deaths in patients with sepsis","volume":"34","author":"A Nabavi","year":"2020","journal-title":"Med J Islam Repub Iran"},{"issue":"2","key":"pone.0294779.ref016","doi-asserted-by":"crossref","DOI":"10.5812\/archcid.93533","article-title":"Relationship Between Lipid Profile and Sepsis Outcome in Intensive Care Unit","volume":"15","author":"M Delirrad","year":"2020","journal-title":"Archives of Clinical Infectious Diseases"},{"key":"pone.0294779.ref017","article-title":"Prognostic Implications of Serum Lipid Metabolism over Time during Sepsis","volume":"2015","author":"SH Lee","year":"2015","journal-title":"Biomed Res Int"},{"key":"pone.0294779.ref018","first-page":"147","article-title":"Is hypertriglyceridemia a prognostic factor in sepsis?","volume":"10","author":"A Cetinkaya","year":"2014","journal-title":"Ther Clin Risk Manag"},{"key":"pone.0294779.ref019","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jcrc.2020.01.016","article-title":"Impact of the pre-illness lipid profile on sepsis mortality","volume":"57","author":"MD Maile","year":"2020","journal-title":"J Crit Care"},{"key":"pone.0294779.ref020","unstructured":"Johnson A, Bulgarelli L, Pollard T, et al., MIMIC-IV (version 1.0). PhysioNet 2021. https:\/\/doi.org\/10.13026\/s6n6-xd98."},{"issue":"8","key":"pone.0294779.ref021","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"M Singer","year":"2016","journal-title":"JAMA"},{"key":"pone.0294779.ref022","doi-asserted-by":"crossref","unstructured":"Fahila R, Kembaren T and Rahimi A. The effect of bacterial sepsis severity on triglyceride value. in 1st International Conference on Tropical Medicine and Infectious Diseases (ICTROMI). 2017. Univ Sumatera Utara, Fac Med, Medan, INDONESIA.","DOI":"10.1088\/1755-1315\/125\/1\/012074"},{"issue":"8","key":"pone.0294779.ref023","doi-asserted-by":"crossref","first-page":"1161","DOI":"10.1194\/jlr.R120000922","article-title":"Aging and plasma triglyceride metabolism","volume":"61","author":"KM Spitler","year":"2020","journal-title":"J Lipid Res"},{"issue":"7","key":"pone.0294779.ref024","doi-asserted-by":"crossref","first-page":"S498","DOI":"10.1086\/432005","article-title":"Triglyceride-rich lipoproteins as agents of innate immunity","volume":"41","author":"AM Barcia","year":"2005","journal-title":"Clin Infect Dis"},{"issue":"8","key":"pone.0294779.ref025","doi-asserted-by":"crossref","first-page":"1210","DOI":"10.1016\/j.metabol.2009.11.014","article-title":"Current concepts in triglyceride metabolism, pathophysiology, and treatment","volume":"59","author":"G AbouRjaili","year":"2010","journal-title":"Metabolism"},{"issue":"12","key":"pone.0294779.ref026","doi-asserted-by":"crossref","first-page":"1765","DOI":"10.1016\/S0022-2275(20)41334-3","article-title":"Endotoxin rapidly induces changes in lipid metabolism that produce hypertriglyceridemia: low doses stimulate hepatic triglyceride production while high doses inhibit clearance","volume":"33","author":"KR Feingold","year":"1992","journal-title":"Journal of Lipid Research"},{"key":"pone.0294779.ref027","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jss.2018.01.021","article-title":"Alterations in energy substrate metabolism in mice with different degrees of sepsis","volume":"227","author":"T Irahara","year":"2018","journal-title":"J Surg Res"},{"issue":"7","key":"pone.0294779.ref028","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1194\/jlr.R300019-JLR200","article-title":"Effects of infection and inflammation on lipid and lipoprotein metabolism: mechanisms and consequences to the host","volume":"45","author":"W Khovidhunkit","year":"2004","journal-title":"J Lipid Res"},{"key":"pone.0294779.ref029","article-title":"Alterations in serum lipid profile in critically ill septic patients: a prospective study","volume":"56","author":"I Karampela","year":"2020","journal-title":"European Respiratory Journal"},{"issue":"3","key":"pone.0294779.ref030","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1097\/01.CCM.0000114820.47460.0A","article-title":"Low apolipoprotein A-I level at intensive care unit admission and systemic inflammatory response syndrome exacerbation","volume":"32","author":"C Chenaud","year":"2004","journal-title":"Crit Care Med"},{"issue":"3","key":"pone.0294779.ref031","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1172\/JCI114765","article-title":"Human very low density lipoproteins and chylomicrons can protect against endotoxin-induced death in mice","volume":"86","author":"HW Harris","year":"1990","journal-title":"J Clin Invest"},{"issue":"7","key":"pone.0294779.ref032","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1177\/0885066620931473","article-title":"Quantitative and Qualitative Assessments of Cholesterol Association With Bacterial Infection Type in Sepsis and Septic Shock","volume":"36","author":"LP Black","year":"2021","journal-title":"J Intensive Care Med"},{"issue":"10","key":"pone.0294779.ref033","doi-asserted-by":"crossref","DOI":"10.26508\/lsa.202101091","article-title":"Serum proteomics reveals disorder of lipoprotein metabolism in sepsis","volume":"4","author":"X Liang","year":"2021","journal-title":"Life science alliance"},{"issue":"1\u20132","key":"pone.0294779.ref034","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.jns.2012.04.018","article-title":"Serum triglyceride level is an important predictor of early prognosis in patients with acute ischemic stroke","volume":"319","author":"KH Choi","year":"2012","journal-title":"J Neurol Sci"},{"issue":"2","key":"pone.0294779.ref035","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1089\/sur.2017.313","article-title":"Hypermetabolism and Nutritional Support in Sepsis","volume":"19","author":"JC Alverdy","year":"2018","journal-title":"Surg Infect (Larchmt)"},{"issue":"9","key":"pone.0294779.ref036","doi-asserted-by":"crossref","first-page":"S436","DOI":"10.1097\/01.CCM.0000278601.93369.72","article-title":"Metabolic support in sepsis and multiple organ failure: more questions than answers","volume":"35","author":"JL Vincent","year":"2007","journal-title":"Crit Care Med"},{"issue":"2","key":"pone.0294779.ref037","doi-asserted-by":"crossref","first-page":"45","DOI":"10.5492\/wjccm.v3.i2.45","article-title":"Metabolic theory of septic shock","volume":"3","author":"J Pravda","year":"2014","journal-title":"World J Crit Care Med"},{"key":"pone.0294779.ref038","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.nut.2017.09.015","article-title":"Changes in lipid metabolism in pediatric patients with severe sepsis and septic shock","volume":"47","author":"ACG Bermudes","year":"2018","journal-title":"Nutrition"},{"key":"pone.0294779.ref039","doi-asserted-by":"crossref","DOI":"10.1186\/s12014-019-9252-2","article-title":"Lipid metabolism impairment in patients with sepsis secondary to hospital acquired pneumonia, a proteomic analysis","volume":"16","author":"NK Sharma","year":"2019","journal-title":"Clin Proteomics"},{"issue":"11","key":"pone.0294779.ref040","doi-asserted-by":"crossref","first-page":"e1009192","DOI":"10.1371\/journal.pgen.1009192","article-title":"Innate immune signaling in Drosophila shifts anabolic lipid metabolism from triglyceride storage to phospholipid synthesis to support immune function","volume":"16","author":"BA Martinez","year":"2020","journal-title":"PLoS Genet"},{"issue":"1","key":"pone.0294779.ref041","doi-asserted-by":"crossref","first-page":"66","DOI":"10.5937\/afmnai39-33239","article-title":"Triglyceride to high density lipoprotein cholesterol ratio is elevated in patients with complicated type 2 diabetes mellitus","volume":"39","author":"S Bilgin","year":"2022","journal-title":"Acta Facultatis Medicae Naissensis"},{"issue":"6","key":"pone.0294779.ref042","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.numecd.2008.09.003","article-title":"Triglyceride\/HDL-cholesterol ratio is an independent predictor for coronary heart disease in a population of Iranian men","volume":"19","author":"F Hadaegh","year":"2009","journal-title":"Nutr Metab Cardiovasc Dis"},{"issue":"3","key":"pone.0294779.ref043","doi-asserted-by":"crossref","first-page":"p224","DOI":"10.30714\/j-ebr.2021370081","article-title":"Could triglyceride to high density lipoprotein-cholesterol ratio predict hepatosteatosis?","volume":"4","author":"O Kurtkulagi","year":"2021","journal-title":"Experimental Biomedical Research"},{"key":"pone.0294779.ref044","doi-asserted-by":"crossref","DOI":"10.3389\/fcell.2019.00108","article-title":"Sepsis: Inflammation Is a Necessary Evil","volume":"7","author":"C Nedeva","year":"2019","journal-title":"Front Cell Dev Biol"},{"issue":"6","key":"pone.0294779.ref045","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/bcpt.13573","article-title":"Combination of bis (alpha-furancarboxylato) oxovanadium (IV) and metformin improves hepatic steatosis through down-regulating inflammatory pathways in high-fat diet-induced obese C57BL\/6J mice","volume":"128","author":"Q Liu","year":"2021","journal-title":"Basic Clin Pharmacol Toxicol"},{"issue":"2","key":"pone.0294779.ref046","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/S0021-9150(01)00656-6","article-title":"Hypertriglyceridemia is associated with an elevated blood viscosity Rosenson: triglycerides and blood viscosity","volume":"161","author":"RS Rosenson","year":"2002","journal-title":"Atherosclerosis"},{"issue":"6","key":"pone.0294779.ref047","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1080\/08830185.2019.1645138","article-title":"The role of pro-inflammatory cytokines in lipid metabolism of metabolic diseases","volume":"38","author":"Y Chen","year":"2019","journal-title":"Int Rev Immunol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,27]],"date-time":"2023-11-27T18:47:05Z","timestamp":1701110825000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0294779"}},"subtitle":[],"editor":[{"given":"Paavani","family":"Atluri","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2023,11,27]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0294779","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,27]]}}}