(934) Evaluation of Efficacy of Levocarnitine for Propofol-induced Hypertriglyceridemia

Introduction: Propofol is one of the preferred agents for sedation as recommended by the 2018 Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS) guidelines. It is recommended over benzodiazepines due to improved short-term outcomes. In turn, hypertriglyceridemia can lead clinicians to discontinue propofol and switch to a less-preferred benzodiazepine-based infusion to mitigate the risk of pancreatitis. One mechanism of propofol-induced hypertriglyceridemia is an acquired carnitine deficiency causing an inability to metabolize free fatty acids; the supplementation of levocarnitine can promote the metabolism of free fatty acids preventing hypertriglyceridemia. The purpose of this study was to evaluate the triglyceride-lowering benefits of levocarnitine supplementation in patients with propofol-induced hypertriglyceridemia.

Methods: This was a retrospective, single center cohort study conducted at Loyola University Medical Center from May 1, 2021, through October 1, 2023, comparing levocarnitine supplementation for propofol-induced hypertriglyceridemia to no supplementation. The primary endpoint was the percent change of serum triglyceride levels from the development of hypertriglyceridemia to day 7. Secondary endpoints included change in sedation to midazolam-based sedation and ICU length of stay. Categorical data was analyzed using the Chi-Square Test. Continuous data was analyzed using the Student T and Mann-Whitney U tests.

Results: There was no difference in the primary outcome. At day 6 of propofol infusion, there was a statistically significant difference in the percent change in triglyceride levels between the levocarnitine and no levocarnitine groups (-18.0% vs 23.1%, p=0.01, respectively). There was no difference in the ICU length of stay between the levocarnitine and no levocarnitine groups (22 vs. 16 days, p=0.18). Levocarnitine was initiated at a median triglyceride level of 412 mg/dL.

Conclusions: There was a statistically significant difference in the percent change in triglyceride levels between groups at day 6 of propofol infusion. Levocarnitine was typically added once a patient already had hypertriglyceridemia limiting successful results, earlier addition can be considered based on levocarnitine’s mechanism of action.