Pathophysiologic correlates of hypocholesterolemia in critically ill surgical patients.

OBJECTIVE

To assess correlates of hypocholesterolemia in moderate to critical surgical illness.

DESIGN

Prospective analysis of laboratory and clinical data.

SETTING

Department of surgery in a university hospital.

PATIENTS

135 patients undergoing uncomplicated abdominal surgery or with sepsis, liver failure, hemorrhage, severe cholestasis, or multiple organ dysfunction syndrome (MODS).

INTERVENTIONS

Surgical and/or medical therapy according to clinical status.

MEASUREMENTS AND MAIN RESULTS

Determinations of total cholesterol, additional variables, and clinical data. Cholesterol decreased after surgery, in sepsis, liver failure, acute hemorrhage, and MODS and increased in cholestasis. Hypocholesterolemia correlated with decreases in plasma proteins and indices of hepatic protein synthetic adequacy, with hemodilution from blood loss, and was moderated or prevented by cholestasis.

CONCLUSIONS

These results help to explain the dynamics of the development, clinical relevance, and negative prognostic value of hypocholesterolemia in critical illness.