Critical Care Medicine

Skip Navigation LinksHome > May 2014 - Volume 42 - Issue 5 > Low Preoperative Cholesterol Level Is a Risk Factor of Sepsi...
Critical Care Medicine:
doi: 10.1097/CCM.0000000000000165
Feature Articles

Low Preoperative Cholesterol Level Is a Risk Factor of Sepsis and Poor Clinical Outcome in Patients Undergoing Cardiac Surgery With Cardiopulmonary Bypass*

Lagrost, Laurent PhD1,2; Girard, Claude MD, PhD1,2; Grosjean, Sandrine MD, PhD1,2; Masson, David PharmD, PhD1,2; Deckert, Valérie PhD1; Gautier, Thomas PhD1; Debomy, Frédérique MS2; Vinault, Sandrine BSc3; Jeannin, Aline MS1; Labbé, Jérôme MS1; Bonithon-Kopp, Claire MD, PhD1,3

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Objectives: Systemic inflammatory response syndrome and sepsis frequently occur after cardiac surgery with cardiopulmonary bypass. The aim of the present study was to investigate whether preoperative cholesterol levels can predict sepsis onset and postoperative complications in patients undergoing cardiac surgery with cardiopulmonary bypass.

Design: Prospective observational study.

Setting: Surgical ICU of a French university hospital.

Patients: Two hundred and seventeen consecutive patients older than 18 years admitted for planned cardiac surgery with cardiopulmonary bypass.

Interventions: Measurements of plasma blood lipids and inflammation markers before anesthesia induction (baseline), at cardiopulmonary bypass start, at cardiopulmonary bypass end, and 3 and 24 hours after cardiac surgery. Outcomes were compared in systemic inflammatory response syndrome patients with sepsis (n = 15), systemic inflammatory response syndrome patients without sepsis (n = 95), and non–systemic inflammatory response syndrome patients (n = 107).

Measurements and Main Results: A gradual decrease in plasma cholesterol concentration occurred during surgery with cardiopulmonary bypass but was no longer present after correction for hemodilution. Corrected cholesterol levels were significantly lower at baseline in sepsis patients than in other subgroups, and it remained lower in the sepsis group during and after cardiopulmonary bypass. With regard to sepsis, the discriminatory power of baseline cholesterol was fairly good as indicated by receiver operating characteristic curve analysis (area under the curve, 0.78; 95% CI, 0.72–0.84). The frequency of sepsis progressively decreased with increasing baseline cholesterol level quintiles (18.6% and 0% in the bottom and top quintiles, respectively, p = 0.005). In multivariate analysis, baseline cholesterol levels and cardiopulmonary bypass duration were significant and independent determinants of the 3-hour postcardiopulmonary bypass increase in concentrations of procalcitonin and interleukin-8, but not of interleukin-6.

Conclusions: Low cholesterol levels before elective cardiac surgery with cardiopulmonary bypass may be a simple biomarker for the early identification of patients with a high risk of sepsis.

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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