Serum cholesterol level: is it a marker of sepsis?

Background

There is no ideal biomarker for sepsis. Recent studies have linked cholesterol levels with critical illness [1]. This study has been conducted to document the baseline cholesterol level in critically ill patents and to correlate its trend with the development, progression and outcome of sepsis.

Method

Prospective analysis of laboratory and clinical data of 184 consecutive patients admitted to a 64-bed critical care unit (CCU) of a tertiary care hospital in South India. Data collected were the demographics, and the cholesterol level at the time of admission, at the onset of sepsis (with or without multiorgan failure) and on discharge from the unit. Sepsis was defined as per the 1992 ACCP consensus conference criteria. MOD scoring was done daily. Patients who were admitted with sepsis and those who developed sepsis during their stay in the unit were considered as the study group, while those who did not develop sepsis acted as the control group. Data were expressed as mean ± standard deviation. The paired Student's t test was used to compare the total cholesterol levels between the two groups. Correlation coefficient and logistic multiple regression analysis was performed with the MOD score, cholesterol levels and mortality. P < 0.05 was considered significant.

Results

A total of 183 patients were enrolled into the study (study group – 73 and control – 110). The mean age was 56.4 ± 18.7 years and the male/female ratio was 1.8:1. The mean admission cholesterol was 212.5 ± 56 mg/dl, while the mean cholesterol level on day 5 was 112.3 ± 34.5 mg/dl in the sepsis group and 179.4 ± 47.6 mg/dl in the control group. The lowest cholesterol levels recorded were in patients who died in the study group: 101.3 ± 18.1 (n = 54). The cholesterol level at the time of discharge from the CCU in the study group (n = 19) was 109.74 ± 20.7 and in the control group (n = 102) was 201 ± 51.3

Discussion

The drop in cholesterol levels during the CCU course shows a correlation with the onset of a new infection and development of sepsis. Lower cholesterol levels were associated with increasing mortality. Convalescence/discharge from CCU was associated with improvement in cholesterol levels.

Conclusion

This study reveals the negative prognostic value of hypocholesterolemia in critical illness. It is a sensitive marker for onset of infection and sepsis.