Severe hypocholesterolemia in surgical patients, sepsis, and critical illness

After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of hypocholesterolemia. In human sepsis, the poor implications of hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.

...The mechanisms involved in decreasing cholesterol may include the effect of inflammatory mediators, the insufficient hepatic synthesis of cholesterol, and hemodilution, the latter being related to blood loss and fluid reinfusion [4]...
...98–279 U/l) [1, 2, 4]. These notions also explain why patients with extreme illness and multiple organ failure may not show very severe hypocholesterolemia if cholestasis is simultaneously present...
...Perhaps, hypocholesterolemia does not simply passively reflect severity of illness, but may also contribute actively to poor prognosis [4, 5]. In fact, hypocholesterolemia might reflect: (1) a reduction of the lipoproteins which protect against microbial products and toxic mediators; (2) a reduced antioxidant capacity of blood through various mechanisms, including the fact that vitamin E (antioxidant) is transported by lipoproteins; and ...
...In surgical trauma and sepsis, plasma triglycerides tend to follow a pattern which is similar to that of cholesterol; however, in sepsis with severe hypocholesterolemia, the development of a dissociated pattern with the simultaneous occurrence of hypertriglyceridemia may reflect an even worse degree of illness, with amplification of the inflammatory response and imminent risk of death [4]...
...The main practical implication, apart from the interruption or the reduction in rate of fat infusion, is that this peculiar pattern signals an extreme severity of illness, in which the only hope of survival is often related to the rapid and aggressive eradication of sepsis [4]...
...Experimental attempts to treat hypocholesterolemia as such include the infusion of fat emulsions with protective properties against endotoxin and the infusion of cholesterol; however, the effects are not yet well determined [4]...

Keywords (8)

Severe hypocholesterolemia in surgical patients, sepsis, and critical illness,10.1016/j.jcrc.2009.08.006,Journal of Critical Care,Carlo Chiarla,Ivo Gi

Citation Context (1)

Gennaro Nuzzo, et al. Plasma cholesterol level after hepatopancreatobiliary surgery provides...

References (28)

Hypotransferrinemia and changes in plasma lipid and metabolic patterns in sepsis (Citations: 2)

Respiratory quotient and patterns of substrate utilization in human sepsis and trauma (Citations: 10)

Fluid resuscitation, nutritional support, and cholesterol in critically ill postsurgical patients (Citations: 8)

Reduction of Circulating Cholesterol and Apolipoprotein Levels during Sepsis (Citations: 21)

Pathophysiologic correlates of hypocholesterolemia in critically ill surgical patients (Citations: 29)

Citations (2)

Plasma cholesterol level after hepatopancreatobiliary surgery provides information on the postoperative clinical course

Ka-band satellite active phased array multi-beam antenna (Citations: 1)


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