HDL Cholesterol as Prognosis Factor in the Critically Ill Patient

Abstract

Introduction: Low seric levels of total cholesterol (TC) and HDLcholesterol (HDL-c) are markers of poor outcome in several diseases.
Material and Methods: Retrospective analysis of 112 patients
admitted in an Intensive Care Unit during a six month period. We
considered 40 mg/dL and 46 mg/dL as critical HDL-c values for
male and female patients. Patients were later divided into 2 groups:
group A (HDL-c ≥ 40/46 mg/dL) and group B (HDL-c < 40/46 mg/
dL). The association between HDL-c levels and the incidence of
severe sepsis/septic shock and mortality was tested.
Results: TC levels were higher in group A (p = 0.016), LDL-c levels
did not differ (p = 0.537) and triglyceride levels were significantly higher in group B (p <0,001). Severe sepsis/septic shock was more
prevalent in group B (p = 0.003). There was a considerable difference
in intra-hospitalary mortality between groups (5.6% in group A vs.
21.1% no group B), very close to statistical significance (p = 0,052).
Discussion: During the acute phase response triggered in sepsis
occurs a drastic modification in lipid profile. In severe sepsis, the
HDL particle undergoes several modifications, becoming the so called acute-phase HDL. In severe forms of sepsis/septic shock,
negative acute phase proteins can be used as independent predictors of survival.
Conclusion: HDL hypocholesterolemia is a marker of poor outcome in critically ill patients and is associated with a higher incidence
of severe sepsis/septic shock and increased mortality