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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

doi: 10.1097/CCM.0000000000000165
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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.

1INSERM Research Center UMR866, University of Burgundy, Dijon, France.

2Department of Anaesthesia-Reanimation, University Hospital of Dijon, Dijon, France.

3INSERM CIE1, Clinical Investigation Center-Clinical Epidemiology, Dijon, France.

* See also p. 1287.

Supported, in part, by grants from the Université de Bourgogne, the Centre Hospitalier Universitaire de Dijon, the Conseil Régional de Bourgogne, the Institut National de la Santé Et de la Recherche Médicale, the Direction de l’Hospitalisation et de l’Organisation des Soins, and a French Government grant managed by the French National Research Agency (ANR) under the program “Investissements d’Avenir” with reference ANR-11-LABX-0021/LipSTIC Labex.

Dr. Girard was a board member with Bristol Myers Squibb and Bayer. Dr. Girard and his institution consulted for Baxter SA, Bayer France, Abbott France, Pfizer, and Air Liquide. Dr. Grosjean participated in the following studies: Reduction in Cardiovascular Events by AcaDesine in Subjects undergoing Coronary Artery Bypass Graft study for Schering-Plough/Merck (2009/2010), Argatroban-E07 study for Mitsubishi Pharmaceuticals (2010/2011), and Pass Clottafact study for Laboratoire Français du fractionnement et des Biotechnologies. Drs. Deckert, Gautier, and Labbé’s institutions received grant support from the French National Research Agency (ANR-11-LABX-0021) and Regional Council of Burgundy. Ms. Vinault’s and Dr. Bonithon-Kopp’s institutions received grant support from the Inserm-French health Ministry. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Laurent Lagrost, PhD, Centre de Recherche Inserm/uB UMR866 “Lipids, Nutrition, Cancer”, Université de Bourgogne, Faculté de Médecine, 7 boulevard Jeanne d’Arc, BP87900, 21079 Dijon cedex, France. E-mail:; Claude Girard, MD, PhD, Département d’Anesthésie et de Réanimation, Centre Hospitalier Universitaire–Hôpital du Bocage, boulevard Maréchal-de-Lattre-de-Tassigny, BP77908, 21079 Dijon cedex, France. E-mail:

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