Cholesterol Rather Than Procalcitonin or C-Reactive Protein Predicts Mortality in Patients With Infection

Abstract

Serum cholesterol procalcitonin (PCT) and C-reactive protein (CRP) levels were measured consecutively in 76 critically ill patients at admission to the intensive care unit. The presence of infection was defined according to the CDC (Centers for Disease Control and Prevention) criteria; in-house mortality, underlying diseases, and severity of sepsis were monitored. Nonsurvivors had significantly lower cholesterol levels compared with survivors (69 mg/dL [range, 37-88 mg/dL] vs. 96 mg/dL [range, 71-132 mg/dL], P = 0.006) whereas no significant differences were noted for serum PCT and CRP levels. In a cohort of patients with cholesterol levels of 50 mg/dL or less, 82% did not survive as compared with patients with cholesterol levels of 100 mg/dL or greater (mortality, 21%). In a control group without infection, no difference of cholesterol, PCT, or CRP was found between survivors and nonsurvivors. Our data show that low cholesterol levels in patients with infectious disease have a prognostic value and may be useful markers to identify high-risk patients already at admission.

The prognostic value of procalcitonin, C-reactive protein and cholesterol in patients with an infection and multiple organ dysfunction

“…Some results differ from those described by Biller et al [17], but are similar to those obtained by Huang et al [19], Ho et al [20], and Litton et al [21]. The use of different intensive therapy protocols for severe infections, initiating early treatment during the period between the onset of infection and the administration of effective antibacterial therapy, source control, and damage to specific target organs in patients with multiple organ dysfunction may affect mortality and alter the statistical significance of biomarkers.…”

“…Our results are comparable with the results obtained by a number of authors. Biller et al [17] found that a cholesterol level > 80 mg/dl is associated with a survival AUC of 0.715 in patients with infection, with sensitivity of 72% and specificity of 66%. Kitazawa et al [15] reported that patients with a bloodstream infection and lower cholesterol levels tended to have higher 30 day mortality, with an AUC of 0.66, sensitivity of 100% and specificity of 39%.…”

“…Available studies have presented conflicting results. Biller et al [17] showed that CRP and PCT levels do not predict mortality (CRP and PCT AUCs of 0.407 and 0.474, respectively). Zhou and Ho [18] found that CRP > 100 mg/L and PCT > 0.6 µg/L at ICU discharge were associated with an increased risk for adverse post-ICU events.…”

Prognostic Significance of Biomarkers in Pulmonary Arterial Hypertension

“…Low cholesterol levels have been associated with an increased risk of sepsis in critically ill as well as surgical patient populations (23,24). Low cholesterol levels have also been associated with poor survival in several patient populations, including the elderly (25) and patients with congestive heart failure (26-28), rheumatoid arthritis (29), and end-stage renal disease (30,31).…”

Hubungan Profil Lipid dan Derajat Keparahan Penyakit berdasarkan Skor Pediatric Logistic Organ Dysfunction-2 pada Anak dengan Sepsis

“…Mekanisme yang menjelaskan penurunan kadar kolesterol masih belum jelas. 19 Namun demikian, hipokolesterolemia yang berat pada sepsis berhubungan langsung dengan respon fase akut. Infeksi akut dan kronik akibat bakteri, virus dan parasit dapat menyebabkan hipokolesterolemia akibat pengaruh sitokin proinflamasi pada metabolisme lipoprotein.…”