Summary
Background
The causes of hypocholesterolemia in the critically ill, including major trauma patients, have not yet been fully elucidated.
Objective
We tested the hypothesis that hypocholesterolemia is caused by decreased production of cholesterol precursors.
Design
Serum concentrations of squalene, lanosterol, and lathosterol were measured on admission, and then at 24 and 48 hours after injury using gas chromatography coupled with mass spectrometry. Serum concentrations of total low-density and high-density lipoprotein cholesterol were measured on admission and every day in the first week after injury.
Results
83 consecutive patients with multiple trauma were examined. Significant drops in concentrations of lanosterol and lathosterol were found in the patients in comparison with the control group. The most profound drop was in lathosterol.
Conclusion
Decreased synthesis of cholesterol precursors is the major cause of hypocholesterolemia in patients with multiple trauma. Lathosterol concentration is proposed as a marker of cholesterol synthesis.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Wolfram G, Eckard J, Zollner N (1980) Disturbances of lipoprotein and fatty acid metabolism in patients with heavy injuries. Klin Wochenschr 58: 1327–1337
Gui D, Spada PL, De Gaetano A, Pacelli F (1996) Hypocholesterolemia and risk of death in the critically ill surgical patient. Intensive Care Med 2: 790–794
Gordon BR, Parker TS, Levine DM, et al (1996) Low lipid concentrations in critically illness: Implications for preventing and treating endotoxemia. Crit Care Med 24: 584–589
Stachon A, Boning A, Weisser H, Laczkovics A, Skipka G, Krieg M (2000) Prognostic significance of low serum cholesterol after cardiothoracic surgery. Clin Chem 46: 1114–11120
Elliot DC, Wiles CE (1997) Low lipid concentrations in critical illness: hypocholesterolemia among trauma patients. Crit Care Med 25: 1437–1439
Giovannini I, Boldrini G, Chiarla C, Giuliante F, Vellone M, Nuzzo G (1999) Pathophysiologic correlates of hypocholesterolemia in critically ill surgical patients. Intensive Care Med 25: 748–751
Voet D, Voet JG (1990) Biochemistry John Wiley & Sons, New York
Memon RA, Shechter I, Moser AH, et al (1997) Endotoxin, tumor necrosis factor, and interleukin-1 decrease hepatic squalene synthase activity, protein, and mRNA levels in Syrian hamsters. J Lipid Res 38: 1620–1629
Osler T, Baker SP, Long W (1997) A modification of the Injury Severity Score that both improves accuracy and simplifies scoring. J Trauma 43: 922–926
Boyd CR, Tolson MA, Copes WS (1987) Evaluating trauma care: The TRISS method. J Trauma 7: 370–373
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13: 818–829
Warnick GR, Benderson J, Albers JJ (1982) Dextran sulphate-Mg2+ precipitation procedure for quantification of high density lipoprotein cholesterol. Clin Chem 28: 1379–1388
Friedewald WT, Levy RI, Fredrickson DS (1972) Estimation of the concentration of low density liporprotein cholesterol in plasma without the use of the preparative ultracentrifugate. Clin Chem 18: 499–502
Dunham CM, Frankenfield D, Belzberg H, et al (1994) Inflammatory markers: Superior predictors of adverse outcome in blunt trauma patients? Crit Care Med 22: 667–672
Sun X, Oberlander D, Huang J, Weismann C (1998) Fluid resuscitation, nutritional support, and cholesterol in critically ill post-surgical patients. J Clin Anesth 10: 302–308
Alvarez C, Ramos A (1986) Lipids, lipoproteins, and apoproteins in serum during infection. Clin Chem 32: 142–145
Gordon BR, Parker TS, Levine DM, et al (2001) Relationship of hypolipidemia to cytokine concentrations and outcomes in critically ill surgical patients. Crit Care Med 29: 1563–1568
Harada K, Shimano H, Kawakami M, et al (1990) Effect of tumor necrosis factor/cachectin on the activity of the low density lipoprotein receptor on human skin fibroblast. Biochem Biophys Res Comm 172: 1022–1027
Feingold KR, Grunfeld C (1987) Tumor necrosis factoralpha stimulates hepatic lipogenesis in the rat in vivo. J Clin Invest 80: 184–190
Borkowski AJ, Levin S, Delcroix C, et al (1967) Blood cholesterol and hydrocortisone production in man: quantitative aspects of the utilization of circulating cholesterol by the adrenals at rest and under adrenocorticotropin stimulation. J Clin Invest 46: 797–811
Mulder M, Lombardi P, Jansen H, van Berkel TJ, Frants RR Havekes LM (1993) Low density lipoprotein receptor internalizes low density and very low density lipoproteins that are bound to heparan sulphate proteoglycans via lipoprotein lipase. J Biol Chem 268: 9369–9375
Chiarla C, Giovannini I, Siegel JH, et al (1990) Relationship of plasma cholesterol level to doses of branch-chain amino acids in sepsis. Crit Care Med 18: 32–36
Cailleux A, Cogny M, Allain P (1992) Decrease of isoprene concentrations in blood during general anaesthesia. Biochem Med Metab Biol 47: 157–160
Oster P, Muchowski H, Heuck CC, Schlierf G (1981) The prognostic significance of hypocholesterolemia in hospitalzed patients. Klin Wochenschr 59: 857–860
Ettiger WH, Varna VK, Sorci-Thomas M, et al (1994) Cytokines decrease apolipoprotein accumulation in medium from HepG2 cells. Arterioscler Throm 14: 8–13
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by grants from the Czech Internal Grant Agency of the Ministry of Health, IGA NB 6112 and NB 7593-3.
Rights and permissions
About this article
Cite this article
Bakalar, B., Hyspler, R., Pachl, J. et al. Changes in cholesterol and its precursors during the first days after major trauma. Wien Klin Wochenschr 115, 775–779 (2003). https://doi.org/10.1007/BF03040502
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03040502