Severe hypocholesterolemia in surgical patients, sepsis, and critical illness

Chiarla, Carlo; Giovannini, Ivo; Giuliante, Felice; Zadák, Z; Vellone, Maria; Ardito, Francesco; Clemente, Gennaro; Murazio, Marino; Nuzzo, Gennaro

doi:10.1016/j.jcrc.2009.08.006

Cited by 46 publications

(46 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…As for lipids, our observation of hypocholesterolaemia is in line with studies presenting the decrease in cholesterol level in septic, surgical and other critically ill patients [49]. Decreased HDL-C accords with findings from other studies on SPs [50].…”

Section: Discussionsupporting

confidence: 91%

Increased inflammatory markers with altered antioxidant status persist after clinical recovery from severe sepsis: a correlation with low HDL cholesterol and albumin

et al. 2015

View full text Add to dashboard Cite

Markers of oxidative stress and antioxidant status in relation to inflammatory mediators in septic patients (SPs) during the course of sepsis and after recovery were analysed. Patients were 30 critically ill adults in severe sepsis/septic shock, 19 of which completed 3 samplings (S1: within 24 h after onset of sepsis, S7: 7 days after S1, R7: 7 days after clinical recovery). Comparing SPs with healthy controls (HCs), enhanced C-reactive protein, procalcitonin, bilirubin and CuZn-superoxide dismutase activity were found at S1 only. Oxidized low-density lipoprotein, conjugated dienes and nitrotyrosine were increased at S1, culminated at S7 and reverted nearly to HC levels at R7. Reduced catalase activity and serum amyloid were observed at S1 and endured until R7. Increase in IL-6, IL-10 and tumour necrosis factor alpha (TNF-α) with accompanying decrease in apolipoprotein A1, high-density lipoprotein (HDL) cholesterol, selenium, zinc, albumin, paraoxonase 1 and glutathione peroxidase 1 activity appeared at S1 and persisted until R7. TNF-α, IL-10 and markers of oxidative stress were in negative correlation with HDL cholesterol and albumin at R7. After clinical recovery, increased cytokines and decreased antioxidants were accompanied by lower albumin and HDL cholesterol levels. During this important and beneficial period of tissue repair, patients with prolonged persistence of this status are probably more vulnerable to secondary infections and should be dealt with as constituting a high-risk population.

show abstract

Section: Discussionsupporting

confidence: 91%

Increased inflammatory markers with altered antioxidant status persist after clinical recovery from severe sepsis: a correlation with low HDL cholesterol and albumin

et al. 2015

View full text Add to dashboard Cite

show abstract

“…Currently, clinical consequences of acute and transient hyperTG remain poorly known, although cases of acute pancreatitis, fatty liver, delayed awakening, retinal lipemia [2,6,8], and elevated mortality particularly in association with hypocholesterolemia [36] have been described. An increased risk of infection by disruption of the reticuloendothelial system [2,33], coagulopathy [25], neurological disturbance or respiratory failure [2] have also been reported, none of which occurred in our patients.…”

Section: Discussionmentioning

confidence: 99%

Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

et al. 2012

View full text Add to dashboard Cite

Purpose: Hypertriglyceridemia (hyperTG) is common among intensive care unit (ICU) patients, but knowledge about hyperTG risk factors is scarce. The present study aims to identify risk factors favoring its development in patients requiring prolonged ICU treatment. Methods: Prospective observational study in the medicosurgical ICU of a university teaching hospital. All consecutive patients staying C4 days were enrolled. Potential risk factors were recorded: pathology, energy intake, amount and type of nutritional lipids, intake of propofol, glucose intake, laboratory parameters, and drugs. Triglyceride (TG) levels were assessed three times weekly. Statistics was based on twoway analysis of variance (ANOVA) and linear regression with potential risk factors. Results: Out of 1,301 consecutive admissions, 220 patients were eligible, of whom 99 (45 %) presented hyperTG (triglycerides [2 mmol/L). HyperTG patients were younger, heavier, with more brain injury and multiple trauma. Intake of propofol (mg/kg/h) and lipids' propofol had the highest correlation with plasma TG (r 2 = 0.28 and 0.26, respectively, both p \ 0.001). Infection and inflammation were associated with development of hyperTG [C-reactive protein (CRP), r 2 = 0.19, p = 0.004]. No strong association could be found with nutritional lipids or other risk factors.Outcome was similar in normo-and hyperTG patients. Conclusions: HyperTG is frequent in the ICU but is not associated with adverse outcome. Propofol and accompanying lipid emulsion are the strongest risk factors. Our results suggest that plasma TG should be monitored at least twice weekly in patients on propofol. The clinical consequences of propofol-related hyperTG should be investigated in further studies.

show abstract

“…Plasma cholesterol behaves like albumin, whose levels tend to decrease in conditions of stress, such as after surgical trauma and with the occurrence of complications (sepsis, liver insufficiency, and hemorrhage). The mechanisms involved in decreasing cholesterol may include the effect of inflammatory mediators, the insufficient hepatic synthesis of cholesterol, and hemodilution, the latter being related to blood loss and fluid reinfusion [4]. The final effect is cumulative, and the severity of hypocholesterolemia reflects the importance of the adverse factors which determine the severity of illness.…”

mentioning

confidence: 99%

“…Postoperatively, however, especially when surgery involves relief of the obstruction, cholesterol decreases and regains a prognostic role. An estimation of the effect of cholestasis may be obtained by considering that cholesterol increases by approximately 7 mg/dl (&0.2 mmol/l) per 100 U/l increase in alkaline phosphatase (n.v. 98-279 U/l) [1,2,4]. These notions also explain why patients with extreme illness and multiple organ failure may not show very severe hypocholesterolemia if cholestasis is simultaneously present.…”

mentioning

confidence: 99%

“…Perhaps, hypocholesterolemia does not simply passively reflect severity of illness, but may also contribute actively to poor prognosis [4,5]. In fact, hypocholesterolemia might reflect: (1) a reduction of the lipoproteins which protect against microbial products and toxic mediators; (2) a reduced antioxidant capacity of blood through various mechanisms, including the fact that vitamin E (antioxidant) is transported by lipoproteins; and (3) a reduced availability of cholesterol in conditions of increased requirement.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Plasma cholesterol level after hepatopancreatobiliary surgery provides information on the postoperative clinical course

Nuzzo

Giovannini

2010

Updates Surg

Self Cite

View full text Add to dashboard Cite

Hypocholesterolemia is commonly considered an index of malnutrition. Conversely, major surgical procedures such as liver resection or pancreaticoduodenectomy and the possibly related adverse events such as sepsis, major bleeding, or other complications may cause a reduction in plasma cholesterol to values even lower than 30 mg/dl. Therefore, in this case, the severity of hypocholesterolemia often becomes an index of severity of illness with relevant prognostic value [1][2][3]. In spite of the fact that cholesterol may be influenced by various other factors, the evolution of hypocholesterolemia (the trend toward worsening or resolution, or the protracted persistence of severe hypocholesterolemia) provides useful information on the clinical evolution of the patient.It is worth outlining the mechanisms which are involved in the development of hypocholesterolemia and some practical cues for its interpretation. Plasma cholesterol behaves like albumin, whose levels tend to decrease in conditions of stress, such as after surgical trauma and with the occurrence of complications (sepsis, liver insufficiency, and hemorrhage). The mechanisms involved in decreasing cholesterol may include the effect of inflammatory mediators, the insufficient hepatic synthesis of cholesterol, and hemodilution, the latter being related to blood loss and fluid reinfusion [4]. The final effect is cumulative, and the severity of hypocholesterolemia reflects the importance of the adverse factors which determine the severity of illness. In our experience, after liver resection, the reduction in cholesterol, with respect to the preoperative value, is cumulatively related to the magnitude of the operation, the possible presence of sepsis and liver insufficiency, and the decrease in hematocrit; in this case, a persistently severe fall in cholesterol correlates with poor prognosis [3, 5] (Fig. 1). The tendency for a greater fall in cholesterol after major abdominal surgery such as after pancreaticoduodenectomy, compared to what is observed after other operations, may at least partly be explained by the magnitude of the operation.The assessment of postoperative cholesterol should also take into account its relative value as a fraction (postoperative/preoperative ratio) or as a percentage of the preoperative level. In any case, the protracted persistence of cholesterol below 60-50 mg/dl (&1.5-1.3 mmol/l) is often associated with severe sepsis, at times occult sepsis which, if not recognized and rapidly treated, may become lethal [3,5]. On the contrary, a transient decrease in cholesterol is less important as long as the levels subsequently steadily increase with the resolution of the underlying problem. Therefore, although plasma cholesterol cannot be used as a precise diagnostic tool, the changes along time may provide useful prognostic information.Cholestasis, if simultaneously present, exerts an opposite influence on the behavior of plasma cholesterol. In fact, cholestasis increases cholesterol, and levels even greater than 400 mg/dl may be observed ...

show abstract

Severe hypocholesterolemia in surgical patients, sepsis, and critical illness

Cited by 46 publications

References 29 publications

Increased inflammatory markers with altered antioxidant status persist after clinical recovery from severe sepsis: a correlation with low HDL cholesterol and albumin

Increased inflammatory markers with altered antioxidant status persist after clinical recovery from severe sepsis: a correlation with low HDL cholesterol and albumin

Hypertriglyceridemia: a potential side effect of propofol sedation in critical illness

Plasma cholesterol level after hepatopancreatobiliary surgery provides information on the postoperative clinical course

Contact Info

Product

Resources

About