High-Density Lipoprotein: A Novel Marker for Risk of In-Hospital Infection in Acute Ischemic Stroke Patients?

Abstract

Background: Several studies have shown that high-density lipoprotein (HDL) cholesterol provides protection against bacterial infections. Our aim was to investigate the influence of HDL cholesterol levels on the risk of developing in-hospital infectious complications after an acute ischemic stroke (IS) as well as the possible effect of prestroke statin treatment on this association. Methods and Results: Observational study that included consecutive IS patients during a 5-year period (2006-2010). We analyzed vascular risk factors, prestroke treatments (including statins), laboratory data (including HDL cholesterol levels), stroke severity, and the development of infectious complications (pneumonia, urinary tract infection and sepsis). A multivariate analysis that included HDL cholesterol levels, prior statin treatment and the interaction between both variables was performed to identify those factors associated with the presence of infectious complications. A total of 1,385 patients were included, 130 of whom (9.4%) developed in-hospital infections. The receiver operating characteristic curve showed the predictive value of HDL cholesterol with an area under the curve of 0.597 (95% CI, 0.526-0.668; p = 0.006) and pointed to 38.5 mg/dl of HDL cholesterol (65.5% sensitivity and 53.4% specificity) as the optimal cutoff level for developing infectious complications during hospitalization. An HDL cholesterol level ≥38.5 mg/dl was an independent predictive factor for lower risk of infection (OR 0.308; 95% CI 0.119-0.795), whereas prestroke statin treatment was not associated with the development of infection. Conclusions: An HDL cholesterol level ≥38.5 mg/dl was independently associated with lower risk for developing infectious complications in acute IS patients. Statins do not influence this association.

The Effects of Statins on Infections after Stroke or Transient Ischemic Attack: A Meta-Analysis

“…After screening the titles and abstracts, 192 publications were excluded, and nine articles were selected for full-text review. Four articles were excluded after full-text review, leaving a total of five studies [ 7 , 10 , 23 , 29 , 30 ] that met the inclusion criteria for this meta-analysis.…”

“…The characteristics of the selected studies are shown in Table 1 . In the five trials, one [ 10 ] was conducted primarily in the United States and Europe, and four [ 7 , 23 , 29 , 30 ] were conducted in European countries. The number of participants ranged from 112 in the study by Becker et al[ 10 ] to 4,731 in the study by Amarenco et al[ 29 ].…”

“…After initial screening based on the title and/or abstract, 192 articles were excluded, and nine articles were chosen for full evaluation. Of those, two articles [ 23 , 24 ] were by the same authors at the same research institution, so they were considered as one study. We chose the study that contained the more recent and complete data on the association between statins and infection after stroke for analysis in the meta-analysis.…”

Association between cholesterol levels and infections after ischemic stroke

“…The role of cholesterol and its effect on ICs after IS remains poorly characterized. One study reported an inverse relationship between high-density lipoprotein cholesterol and infections after stroke [3]. However, diagnosis of ICs was not based on validated criteria and the analyses were not adjusted for dysphagia, an important predictor of ICs in stroke patients [4].…”

Avaliação nutricional e do perfil lipídico de crianças e adolescentes, com processo inflamatório, em unidade de emergência de um hospital universitário

“…Níveis baixos de HDL em adultos com sepse foram associados com maior mortalidade e maior tempo de internação em UTI (Chien et al, 2005). Em estudo observacional que incluiu 1385 pacientes vitimas de acidente vascular cerebral, evidenciou um papel protetor da HDL contra o desenvolvimento de infecção hospitalar, principalmente em concentrações ≥ 35 mg/dL (Rodríguez et al, 2013). Em crianças com mediana de idade de quatro anos, submetidas à cirurgia cardíaca para correção de ventrículo único (cirurgia de Fontan), com necessidade de circulação extracorpórea, observou-se uma significativa redução das concentrações de HDL no pós-operatório, porém sem correlação significativa com o tempo de drenagem torácica ou a presença de derrame pleural quiloso (p = 0,09) (Zyblewski et al, 2012).…”