(377) Association of Triglyceride Level and Clinical Outcomes in Propofol-Induced Hypertriglyceridemia

Introduction: Propofol is a first-line sedative agent in mechanically ventilated patients as benzodiazepine (BZD)-based regimens have been associated with longer intensive care unit (ICU) length of stay (LOS), longer duration of mechanical ventilation (MV), and increased risk of delirium. Propofol is formulated in a lipid-based emulsion that can elevate triglyceride (TG) levels, which can limit its use despite demonstrated benefits over alternatives. Hypertriglyceridemia (HTG) secondary to propofol, defined as TG ≥400 mg/dL, has a 15-40% incidence. Despite this high occurrence, the risk of associated pancreatitis is rare. While HTG can limit propofol use, other clinical outcomes due to propofol-induced HTG have yet to be described.

Methods: This was a single-center, observational, retrospective, cohort study conducted on mechanically ventilated patients admitted to the surgical/trauma ICU or medical ICU from July 2019 to July 2022 at Loyola University Medical Center. Patients were included if they received continuous infusion propofol for light sedation for ≥48 hours, and were excluded if given continuous infusions of BZD. The primary endpoint was ICU LOS. Secondary outcomes included duration of MV, hospital LOS, in-hospital and 28-day mortality. Factors associated with increased ICU LOS were analyzed using a multivariate linear regression.

Results: Overall, 645 patients were screened and 252 were included. The main reasons for exclusion were duration of propofol < 48h (n=178) followed by deep sedation (n=72). A total of 41 (16.3%) patients developed TG ≥400 mg/dL and no patients developed pancreatitis. Patients with peak TG ≥400 mg/dL had longer ICU LOS (18 vs 12 days, p< 0.01), longer hospital LOS (21 vs 29 days, p=0.01), and longer duration of MV (7 vs 11 days, p< 0.01). Death did not significantly differ between groups. Duration of MV and TG ≥400 mg/dL were both independently associated with increased ICU LOS in a multivariate linear regression.

Conclusions: Patients who developed peak TG ≥400 mg/dL due to propofol infusion had significantly longer ICU LOS when compared to patients with peak TG < 400 mg/dL. Future studies are warranted to determine how these clinical outcomes compare to BZDs for optimal sedation selection in setting of HTG.