Hypocholesterolemia and risk of death in the critically ill surgical patient
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To evaluate the additional information provided by the determination of cholesterolemia to the Acute Physiology and Chronic Health Evaluation (APACHE) II score.
Retrospective evaluation of patients admitted to the intensive care unit (ICU).
ICUs in a university hospital.
638 consecutive critically ill surgical patients.
Surgical and medical therapy according to clinical status.
Measurements and main results
Two indices were devised: DELCUPOS and DELCUNEG (cubed absolute value of the difference between measured cholesterol and the value of 190 mg/dl when cholesterolemia was, respectively, over and under 190 mg). The first estimation of cholesterolemia was taken upon admission to the ICU. The APACHE II score was computed from the worst values obtained during the first 24 h of the ICU stay, including the pre-operative period for patients transferred from the operating theatre. Mortality (24.4%) over the whole time of hospitalization has been considered. A stepwise linear logistic regression on APACHE II, DELCUPOS, DELCUNEG, and on interactions among these three factors has been carried out. A U-shaped relationship between cholesterolemia and mortality was demonstrated. The significance of DELCUPOS (p=0.0021) and DELCUNEG (p=0.0002), considered together with the APACHE II score, has demonstrated an additive information content with respect to the APACHE score for the prediction of mortality.
Both hyper- and hypocholesterolemia have a highly significant relationship to mortality. Cholesterolemia improves the prognostic power of the APACHE II score. This result could be used to create a more powerful prognostic index.
Key wordsHypocholesterolemia Death rate Cholesterol Mortality APACHE Critical illness
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- 1.Jacobs D, Blackburn H, Higgins M, Reed D, Iso H, McMillan G, Neaton J, Nelson J, Potter J, Rifkind B, Rossouw J, Shekelle R, Yusuf S (1992) Report of the conference on low blood cholesterol: mortality associations. Circulation 86: 1046–1060Google Scholar
- 2.Watson WC, Buchanan KD, Dickson C (1963) Serum cholesterol levels after myocardial infarction. BMJ 2: 709–712Google Scholar
- 3.Lorber M, Aviram M, Linn S, Scharf Y, Brook JG (1985) Hypocholesterolemia and abnormal high-density lipoprotein in rheumatoid arthritis. Br J Rheumatol 24: 250–255Google Scholar
- 4.Hailer S, Adolph M, Eckart J, Wolfram G (1982) Apolipoproteine und Lipide im Serum von Schwerverletzten in Abhängigkeit von der Ernährung. Infusionstherapie 9: 302–309Google Scholar
- 5.Sammalkorpi K, Valtonen V, Kerttula Y, Nikkila E, Taskinen MR (1988) Changes in serum lipoprotein pattern induced by acute infections. Metabolism 37: 859–865Google Scholar
- 6.Chao F, Efron B, Wolf P (1975) The possible prognostic usefulness of assessing serum proteins and cholesterol in malignancy. Cancer 28: 1223–1229Google Scholar
- 7.McLaren DS, Pellet PL, Read WWC (1967) A simple scoring system for classifying the severe forms of protein-calorie malnutrition of early childhood. Lancet I: 533–535Google Scholar
- 8.Bastos PG, Knaus WA (1991) APACHE III study: a summary. Intensive Care World 8: 35–38Google Scholar
- 9.Rudman D, Mattson DE, Nagraj HS, Feller AG, Jackson DL, Caindec N, Rudman IW (1988) Prognostic significance of serum cholesterol in nursing home men. JPEN J Parenter Enteral Nutr 12/II: 155–158Google Scholar
- 10.Auerbach BJ, Parks JS (1989) Lipoprotein abnormalities associated with lipopolysaccharide induce LCAT and lipase deficiency in the African green monkey. J Biol Chem 264: 10264–10270Google Scholar
- 11.Ettinger WH, Miller LD, Albers JJ, Smith TK, Parks JS (1990) Lipopolysaccharide and tumor necrosis factor cause a fall in plasma concentration of lecithin: cholesterol acyltransferase in cynomolgus monkeys. J Lipid Res 31: 1099–1107Google Scholar
- 12.Varma VK, Parks J, Smith T, Ettinger WH (1990) Tumor necrosis factor and interleukin-1 decrease secretion of lecithin: cholesterol acyl-transferase by HepG2 cells. Clin Res 38: 327AGoogle Scholar
- 13.Verdery RB, Goldberg AP (1991) Hypocholesterolemia as a predictor of death: a prospective study of 224 nursing home residents. J Gerontol 46: M84-M90Google Scholar
- 14.Bretscher MS, Munro S (1993) Cholesterol and the Golgi apparatus. Science 261: 1280–1281Google Scholar
- 15.Engelberg H (1992) Low serum cholesterol and suicide. Lancet 339: 727–729Google Scholar
- 16.Noel MA, Smith TK, Ettinger W (1991) Characteristics and outcomes of hospitalized older patients who develop hypocholesterolemia. J Am Geriatr Soc 39: 455–461Google Scholar
- 17.Knaus WA, Draper E, Wagner D (1989) APACHE III study design: analytic plan for evaluation of severity and outcome. Crit Care Med 17: S176-S221Google Scholar