The prognostic value of hypocholesterolemia in hospitalized patients

Clinical observations show that severe illness often leads to hypocholesterolemia. To verify this finding and to define the relationship between serum cholesterol and a patient's prognosis, a study was conducted in two large hospital populations. Of 24,000 and 61,463 adult patients (populations I and II) an average of 3.8% and 3.6% died in hospital, respectively. The mean serum cholesterol levels of patients who died was significantly lower than that of those who survived (163.6 mg/dl versus 217.8 mg/dl;P < 0.0001). The average cholesterol of surviving patients was similar to that of 6,543 healthy controls. During hospitalization serum cholesterol levels of 100 mg/dl were encountered in 1.2% and 3.6% of patients of populations I and II, respectively. The mortality of these hypocholesterolemic patients was about tenfold higher than average and showed a strong, inverse, linear relationship with serum cholesterol concentrations. Patients whose serum cholesterol level dropped to less than 45 mg/dl did not survive. These data show that in severely ill patients serum cholesterol may decline to very low concentrations, and the prognosis is reflected by the degree of hypocholesterolemia, which thus may serve as a clinically useful prognostic parameter. Correspondence to: E. Windler     

低胆固醇血症与某些疾病的相关性

目的探讨低胆固醇血症与癌症、非癌性呼吸系统疾病、脑卒中、心脏病等疾病的相关性。方法分析2251例四类疾病患者的年龄、性别、血脂及疾病的有关情况。结果除结肠(直肠)癌外,其余癌症患者低胆固醇血症发生率明显高于胆固醇正常或增高者(P<0.01),男性多于女性(P<0.01);非癌性呼吸系统常见疾病如慢性支气管炎、肺气肿、支气管哮喘、支气管扩张及肺炎、肺部感染等患者低胆固醇血症发生率明显高于血胆固醇正常或增高者(P<0.01);出血性脑卒中(脑出血)患者低胆固醇血症发生率明显高于血胆固醇正常或增高者(P<0.01),缺血性脑卒中(脑梗死)患者高低胆固醇血症发生率比较差异无显著性(P>0.05);冠心病患者血胆固醇增高和正常者与低胆固醇血症的发生率有明显差异(P<0.01),风湿性心脏病患者低胆固醇血症与非低胆固醇患者相比差异有显著性(P<0.05)。结论低胆固醇血症与癌症、非癌性呼吸系统疾病、出血性脑卒中、心脏病等有密切的或一定的关系,应引起人们的高度重视。     

Hypocholestérolémie du sujet âgé : influence de l’inflammation et de la dénutritionHypocholesterolemia in hospitalized elderly: relations with inflammatory and nutritional status

PURPOSE: Hypocholesterolemia is a common finding in hospitalized elderly people and is associated with increased mortality. Changes in plasma lipid levels are well known in the acute phase response. It has also been suggested that malnutrition is a cause of hypocholesterolemia. However, malnutrition is the reflect of general condition, and the respective roles of malnutrition and inflammation have not yet been clearly established. This research project was undertaken to examine the impact of nutritional and inflammatory status on the hypocholesterolemia. METHODS: In a prospective study, 597 elderly patients (83 +/- 7 years) consecutively admitted in a geriatric acute care unit were included. Clinical and anthropometric data: Body Mass Index (BMI), Tricipital Skinfold Thickness (TSF), Sub-Scapular Skinfold Thickness (SSF), Mid Arm Circumference (MAC) have been collected. The blood samples were obtained within the 72 hours following the admission. Nutritional proteins (albumin, prealbumin, transferrin, retinol binding protein); inflammatory proteins (CRP, alpha-1 acid glycoprotein), and blood lipids (cholesterol, LDL, HDL cholesterol, triglycerides, apoproteins A1 and B) were dosed. RESULTS: The anthropometric and biologic parameters have been compared on the two sexes, significant differences were observed only for blood lipids. The analyses are thus realized and presented by sex separately. Four groups of patients are generated according to the quartile of total cholesterol. Means and standard deviation for all factors are calculated within each group. Both, the trend of means and analyses of correlation show associations with cholesterol in the two sexes. The analysis of variance showed that the cholesterolemia is associated with 1/ decrease in the values of the anthropometrics, and nutritional proteins and 2/ upward trends of the inflammatory parameters. Significant correlations were observed for all transport proteins and CRP with total cholesterol in men and women. The multiple linear regression of the total cholesterol retained albumin, APO A1, APO B and RBP as predictor factors of cholesterolemia for women and APO A1, APO B and tryglicerid for men. When patients with infectious diseases were compared to the others, significant differences have been observed for total cholesterol and all blood lipids, as well as for nutritional and inflammatory proteins. CONCLUSION: The results confirm an association between nutritional status and hypocholesterolemia, and suggest also the responsability of inflammation as a cause of hypocholesterolemia.     

Factors Prognostic of Survival in Patients Awaiting Liver Transplantation for End-Stage Liver Disease

In this study, we investigated possible independent predictive factors for survival, other than MELD score, in patients with cirrhosis. We reviewed the serum sodium, cholesterol, albumin, and platelet levels of 99 patients with cirrhosis and investigated the possible correlation of these parameters with survival period. We found that 77% and 81% of patients with cirrhosis were hypocholesterolemic and hypoalbuminemic, respectively. We noted that the survival time of 6 months in patients with serum sodium levels <125 mM at the time of admission to the study was 27% less than that in patients with sodium levels >130 mM. Patients with cirrhosis and serum sodium levels >130 mM survived for more than 1 year (95% CI). MELD scores of patients with serum sodium levels >130, between 125 and 129, and <125 mM were 15.8 to 19.9, 19.7 to 23.6, and 23.3 to 27.2, respectively (95% CI). In conclusion, we suggest that although all of these parameters are correlated with survival in patients with cirrhosis, the serum sodium level is the most accurate prognostic factor and a valid tool for predicting survival when considered in combination with the MELD score.     

60岁以上老人低胆固醇血症问题的初步探讨

目的　研究 6 0岁以上老人血胆固醇水平及其与某些疾病 ,对血清胆固醇增高或降低的利与弊进行再认识。方法　以来院体检的 2 0 11名 6 0岁以上老人为对象 ,对血胆固醇增高或降低时某些疾病的发病率进行对比分析。结果　老年人群中胆固醇低于 4 2mmol/L (称为低胆固醇血症 )的发生率为 2 4 0 % ,男性居多 ;低胆固醇血症时气管炎、肺气肿等非癌性肺病的发病率与高胆固醇血症间差别有显著性意义 (P <0 0 0 5 ) ;在低胆固醇血症时 ,原发性高血压、冠心病等心血管疾病仍有相当的发病率。结论　血胆固醇水平偏低并非纯利无害 ,值得进一步研究     

Hypocholesterolemia in Patients with an Amebic Liver Abscess

Background/Aims

Many parasites induce changes in the lipid profiles of the host. Cholesterol increases the virulence of Entamoeba histolytica in animal models and in vitro culture. This study aimed to determine, in patients with an amebic liver abscess, the correlation between cholesterol and other features, such as the size and number of abscesses, standard hematological and serum chemistry profiles, liver tests, and duration of hospital stay.

Methods

A total of 108 patients with an amebic liver abscess and 140 clinically healthy volunteers were investigated. Cholesterol and triglycerides were measured in the sera. The data from medical observations and laboratory tests were obtained from the clinical records.

Results

A total of 93% of patients with an amebic liver abscess showed hypocholesterolemia not related to any of the studied parameters. Liver function tests correlated with the size of the abscess. The most severe cases of amebic liver disease or death were found in patients whose cholesterol levels continued to decrease despite receiving antiamebic treatment and hospital care.

Conclusions

Our results show that the hypocholesterolemia observed in patients with an amebic liver abscess is not related to any of the clinical and laboratory features analyzed. This is the first study relating hypocholesterolemia to severity of hepatic amebiasis.     

预后的危险信号:低胆固醇血症

胆固醇是小分子脂溶性物质,是构成生物膜的必需成分.低胆固醇血症对机体的影响,长期以来未受到足够重视.该文作者复习了近年来相关文献,总结了低胆固醇血症的发生因素,及其与预后的相关性.提示在外科中,低胆固醇血症是常见的,而且低胆固醇血症对预后具有负面影响,主要表现为近期病死率和并发症发生率增加.而有关低胆固醇血症的基础研究尚有待进一步研究.     

原发性与继发性低胆固醇血症

低胆固醇血症是指由原发性或继发性因素引起的血清总胆固醇水平降低,通常无明显的临床表现,主要通过常规的血脂检查发现.由于高胆固醇血症是冠心病的重要危险因素,人们长期以来主要关注高胆固醇血症及其对机体的不良影响,而忽视了低胆固醇血症及其对机体的危害,近年来,人们逐渐认识到低胆固醇血症是一种常见的血脂异常,其不仅与多种疾病的发生有关,而且也与一些疾病的不良预后有关,再加上强化降脂治疗的实施和他汀类药物适应证的扩大,低胆固醇血症也正在越来越多地引起人们的重视.     

The increase in skin 7-dehydrocholesterol induced by an hypocholesterolemic agent is associated with elevated 25-hydroxyvitamin D3 plasma level

Vitamin D3 is generated in skin by UV irradiation of 7-dehydrocholesterol (7-DEHC). Whether the 7-DEHC amount in skin affects vitamin D3 formation, and thereby the plasma level of 25-hydroxyvitamin D3 (25[OH]D3) is not known. In the present work we report on the influence on vitamin D and Ca metabolism of a new hypocholesterolemic agent, HCG-917 (0-2-[hydroxy-3-]N-(2-chlorophenyl)-N-piperazinyl-1-[propyl]-4-chloro-benz-aldoxim-hydrochloride) which inhibits 7-DEHC reductase and thereby increases skin 7-DEHC. Rats were treated with HCG 917 (0.3 and 5.0 mg/kg, orally) for 13 days. HCG 917 caused a dose-dependent decrease in cholesterol and concomitant accumulation of 7-DEHC in plasma and skin. In skin, 7-DEHC was: control: 1.05±0.20; HCG 917, 0.3 mg/kg: 1.41±0.22; HCG 917, 5.0 mg/kg: 2.35±0.35 mg/g. At a dose of 0.3 mg/kg, HCG 917 had no significant influence on the plasma level of neither 25(OH)D3 nor 1,25(OH)2D3. However, at a dose of 5.0 mg/kg, HCG 917 induced a significant increase in plasma 25(OH)D3 (control: 36.2±2.2; HCG 917 5.0 mg/kg: 57.6±6.5 nmol/l) and a slight but not significant rise in 1,25(OH)2D3. Calcium balance studies indicated that HCG 917 did not influence intestinal Ca absorption nor urinary Ca excretion. At a dose of 5.0 mg/kg HCG 917 slightly induced a decrease in total plasma Ca. In conclusion, HCG 917 treatment can induce a significant rise in skin 7-DEHC with an increase in plasma 25(OH)D3. These results suggest that variation in the skin level of 7-DEHC can directly influence the cutaneous production of vitamin D3 and thereby the vitamin D status of the organism.