Li Yang, Ge Jianli, Geng Shasha, Li Qingqing, Chen Xin, Zhu Yingqian, Guo Xiaotong, Gu Huajie, Liu Yue
Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, 200120, China.
Lipids Health Dis. 2025 Mar 27;24(1):122. doi: 10.1186/s12944-025-02545-2.
The relationship between dyslipidemia and mortality varies by age, with an inverse association observed in the oldest age groups. There is limited research examining lipid profiles' correlation with short-term mortality risk in older adults. This study aimed to investigate associations of lipid profiles and lipid ratios with 28-day mortality risk in non-surgical older patients with critical illnesses.
A retrospective cohort study was conducted with non-surgical older patients with critical illness who were admitted to the ICU of Shanghai East Hospital between January 2022 and November 2024. All data were collected via the hospitalization information system. Elastic network models were used to select covariates and Cox proportional hazards models were constructed to examine the association of lipid profiles and lipid ratios with 28-day mortality risk. Restricted cubic splines were used to test for non-linear relationships. Subgroup analyses were performed based on median age and gender.
The median age of study's participants was 75 years, 35.91% of whom were female. Those who died within 28 days were more likely to receive dopamine, norepinephrine and mechanical ventilation than survivors. Adjusted models indicated that LDLC (HR = 0.82, 95% CI: 0.69 to 0.97), lbLDLC (HR = 0.79, 95% CI: 0.63 to 0.98), sdLDLC (HR = 0.44, 95% CI: 0.24 to 0.83), LDLC/HDLC (HR = 0.85, 95% CI: 0.73 to 1.00), and sdLDLC/HDLC (HR = 0.63, 95% CI: 0.40 to 1.00) were associated with decreased 28-day mortality risk. However, no non-linear associations were detected. In younger older adults (age < 75 years), TC, non HDLC, remanent C, TC/HDLC and remanent C/HDLC were related to increased short-term mortality risk. In very old adults, TC, LDLC, lbLDLC, sdLDLC, non HDLC, TC/ HDLC, LDLC/HDLC, lbLDLC/HDLC, and sdLDLC/HDLC were associated with lower 28-day mortality risk. In women, only lower sdLDLC was associated with increased short-term mortality risk.
Lower levels of LDLC and its subtypes (lbLDLC, sdLDLC) were associated with increased 28-day mortality risk, particularly in patients aged ≥ 75 years and women. Conversely, elevated residual cholesterol levels correlated with higher mortality in younger older adults (< 75 years). These findings underscore the need for age- and sex-specific lipid management strategies in older patients with critical illnesses.
血脂异常与死亡率的关系因年龄而异，在最高龄组中观察到负相关。关于老年人血脂谱与短期死亡风险相关性的研究有限。本研究旨在调查非手术重症老年患者血脂谱和血脂比值与28天死亡风险的关联。
对2022年1月至2024年11月期间入住上海东方医院重症监护病房的非手术重症老年患者进行回顾性队列研究。所有数据通过住院信息系统收集。采用弹性网络模型选择协变量，并构建Cox比例风险模型以检验血脂谱和血脂比值与28天死亡风险的关联。使用受限立方样条检验非线性关系。根据年龄中位数和性别进行亚组分析。
研究参与者的年龄中位数为75岁，其中35.91%为女性。与幸存者相比，在28天内死亡的患者更有可能接受多巴胺、去甲肾上腺素和机械通气。调整后的模型表明，低密度脂蛋白胆固醇（HR = 0.82，95%CI：0.69至0.97）、低密度脂蛋白胆固醇下限（HR = 0.79，95%CI：0.63至0.98）、低密度脂蛋白胆固醇标准差（HR = 0.44，95%CI：0.24至0.83）、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇（HR = 0.85，95%CI：0.73至1.00）和低密度脂蛋白胆固醇标准差/高密度脂蛋白胆固醇（HR = 0.63，95%CI：0.40至1.00）与降低28天死亡风险相关。然而，未检测到非线性关联。在较年轻的老年人（年龄<75岁）中，总胆固醇、非高密度脂蛋白胆固醇、残余胆固醇、总胆固醇/高密度脂蛋白胆固醇和残余胆固醇/高密度脂蛋白胆固醇与短期死亡风险增加有关。在高龄老年人中，总胆固醇、低密度脂蛋白胆固醇、低密度脂蛋白胆固醇下限、低密度脂蛋白胆固醇标准差、非高密度脂蛋白胆固醇、总胆固醇/高密度脂蛋白胆固醇、低密度脂蛋白胆固醇/高密度脂蛋白胆固醇、低密度脂蛋白胆固醇下限/高密度脂蛋白胆固醇和低密度脂蛋白胆固醇标准差/高密度脂蛋白胆固醇与较低的28天死亡风险相关。在女性中，只有较低的低密度脂蛋白胆固醇标准差与短期死亡风险增加有关。
较低水平的低密度脂蛋白胆固醇及其亚型（低密度脂蛋白胆固醇下限、低密度脂蛋白胆固醇标准差）与28天死亡风险增加相关，特别是在年龄≥75岁的患者和女性中。相反，残余胆固醇水平升高与较年轻老年人（<75岁）的较高死亡率相关。这些发现强调了在重症老年患者中制定针对年龄和性别的血脂管理策略的必要性。
