Onder Graziano, Landi Francesco, Volpato Stefano, Fellin Renato, Carbonin Pierugo, Gambassi Giovanni, Bernabei Roberto
Department of Geriatrics, Catholic University of the Sacred Heart, Rome, Italy.
Am J Med. 2003 Sep;115(4):265-71. doi: 10.1016/s0002-9343(03)00354-1.
Although total cholesterol levels among middle-aged persons correlate with long-term mortality from all causes, this association remains controversial in older persons. We explored whether total cholesterol levels were independently associated with in-hospital mortality among elderly patients.
We analyzed data from a large collaborative observational study, the Italian Group of Pharmacoepidemiology in the Elderly (GIFA), which collected data on hospitalized patients. A total of 6984 patients aged 65 years or older who had been admitted to 81 participating medical centers during four survey periods (from 1993 to 1998) were enrolled. Patients were divided into four groups based on total cholesterol levels at hospital admission: <160 mg/dL (n = 2115), 160 to 199 mg/dL (n = 2210), 200 to 239 mg/dL (n = 1719), and >or=240 mg/dL (n = 940).
Patients (mean [+/- SD] age, 78 +/- 7 years) were hospitalized for an average of 15 +/- 10 days. The mean total cholesterol level was 186 +/- 49 mg/dL. A total of 202 patients died during hospitalization. Mortality was inversely related to cholesterol levels (<160 mg/dL: 5.2% [110/2115]; 160-199 mg/dL: 2.2% [49/2210]; 200-239 mg/dL: 1.6% [27/1719]; and >or=240 mg/dL: 1.7% [16/940]; P for linear trend <0.001). After adjustment for potential confounders (demographic characteristics, smoking, alcohol use, indicators of nutritional status, markers of frailty, and comorbid conditions), low cholesterol levels continued to be associated with in-hospital mortality. Compared with patients who had cholesterol levels <160 mg/dL, the odds ratios for in-hospital mortality were 0.49 (95% confidence interval [CI]: 0.34 to 0.70) for participants with cholesterol levels of 160 to 199 mg/dL, 0.41 (95% CI: 0.26 to 0.65) for those with cholesterol levels of 200 to 239 mg/dL, and 0.56 (95% CI: 0.32 to 0.98) for those with cholesterol levels >or=240 mg/dL. These estimates were similar after further adjustment for inflammatory markers and after excluding patients with liver disease.
Among older hospitalized adults, low serum cholesterol levels appear to be an independent predictor of short-term mortality.
尽管中年人总胆固醇水平与全因长期死亡率相关，但这种关联在老年人中仍存在争议。我们探讨了总胆固醇水平是否与老年患者的住院死亡率独立相关。
我们分析了一项大型协作观察性研究——意大利老年药物流行病学组（GIFA）的数据，该研究收集了住院患者的数据。共有6984名65岁及以上的患者在四个调查期（1993年至1998年）被纳入81个参与研究的医疗中心。根据入院时的总胆固醇水平，患者被分为四组：<160mg/dL（n = 2115）、160至199mg/dL（n = 2210）、200至239mg/dL（n = 1719）和≥240mg/dL（n = 940）。
患者（平均[±标准差]年龄，78±7岁）平均住院15±10天。平均总胆固醇水平为186±49mg/dL。共有202名患者在住院期间死亡。死亡率与胆固醇水平呈负相关（<160mg/dL：5.2%[110/2115]；160 - 199mg/dL：2.2%[49/2210]；200 - 239mg/dL：1.6%[27/1719]；≥240mg/dL：1.7%[16/940]；线性趋势P<0.001）。在对潜在混杂因素（人口统计学特征、吸烟、饮酒、营养状况指标、虚弱标志物和合并症）进行调整后，低胆固醇水平继续与住院死亡率相关。与胆固醇水平<160mg/dL的患者相比，胆固醇水平为160至199mg/dL的参与者住院死亡率的比值比为0.49（95%置信区间[CI]：0.34至0.70），胆固醇水平为200至239mg/dL的参与者为0.41（95%CI：0.26至0.65），胆固醇水平≥240mg/dL的参与者为0.56（95%CI：0.32至0.98）。在进一步调整炎症标志物并排除肝病患者后，这些估计值相似。
在老年住院成年人中，低血清胆固醇水平似乎是短期死亡率的独立预测因素。
