Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery

Palma, Silvia; Cosano, A.; Mariscal, Marcial; Martı́nez-Gallego, Gabriel; Medina-Cuadros, Marcelino; Delgado-Rodrı́guez, Miguel

doi:10.1002/bjs.5626

Cited by 28 publications

(15 citation statements)

References 33 publications

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“…These patients are of course most likely to have suffered a recent weight loss of Ͼ10% of body weight and to have lower mean albumin levels, both of which are well-known risk factors for adverse surgical outcomes. [41][42][43] Underweight patients suffer from proteinenergy malnutrition, and this major aberration in energy metabolism and the malnourished state itself lead to impaired immunologic response mechanisms. Patients with a BMI Յ18.5 kg/m 2 who require general surgical procedures, especially those with recent weight loss and hypoalbuminemia, should perhaps receive a short course of perioperative nutritional supplementation in an effort to reduce this increased risk of postoperative mortality.…”

Section: Discussionmentioning

confidence: 99%

The Obesity Paradox

Mullen¹,

Moorman²,

Davenport³

2009

Annals of Surgery

460

121

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Section: Discussionmentioning

confidence: 99%

The Obesity Paradox

Mullen¹,

Moorman²,

Davenport³

2009

Annals of Surgery

460

121

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“…After combining and critically reviewing an expanding literature, there is an impression that HC is the conventional, if not universal, human response to severe trauma, [10,11,15-17] surgery, [18,24-26] infection, [10,11,16,21,22] and critical illness [27]. It is also noteworthy the degree of HC has been shown to correlate with death in ICU, [27] general surgical, [25,26] trauma, [16] and cardiothoracic surgical [24] patients.…”

Section: Discussionmentioning

confidence: 99%

“…It is also noteworthy the degree of HC has been shown to correlate with death in ICU, [27] general surgical, [25,26] trauma, [16] and cardiothoracic surgical [24] patients. It is also compelling that patients with resolution of infection and discharged alive from the ICU have been shown to have a significant improvement in HC [11,24].…”

Section: Discussionmentioning

confidence: 99%

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Dunham

Chirichella

2011

Lipids Health Dis

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BackgroundPost-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP.MethodsWe performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS), shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP.ResultsThe 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p < 0.0001). TC was 110.7 mg/dL with expected TC 197.5 mg/dL. TC was lower with chest injury, shock, and RBC transfusion but, higher with brain injury (p ≤ 0.01). TC decreased as ISS increased (p = 0.01). However, one patient subset (ISS ≥ 20-&-TC ≥ 90 mg/dL) had a relative increase in TC despite an increase in ISS. ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only independent predictor of late VAP (OR 3.0; p = 0.002). ISS ≥ 20-&-TC ≥ 90 mg/dL and day-one hypoxemia were the only independent predictors for increased ventilator days (p = 0.01). ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only predictor of death (OR 3.8; p = 0.03).ConclusionsSevere traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL) represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death.

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“…EPIC-Norfolk 100 included populations suffering from metabolic syndrome and contributed data to CVD events (adjusted) outcome data. Finally, Palma 2007 148 comprised a population of post-surgical patients, who provided results to all-cause mortality outcome data. Owing to lack of study numbers no subgroup analysis was completed for these baseline comorbidities.…”

Section: Appendix 1 Excluded Referencesmentioning

confidence: 99%

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

Perera

McFadden

McLellan

et al. 2015

Health Technol Assess

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BackgroundVarious lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation.ObjectiveTo determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD.Data sourcesWe searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke’s Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature.MethodsIn two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year.ResultsA total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I2 = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention.LimitationHeterogeneity in meta-analyses.ConclusionsWhile acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence.Study registrationThis study is registered as PROSPERO CRD42013003727.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery

Abstract: Low levels of serum albumin, total cholesterol and HDL-C are associated with death after discharge from hospital in patients having general surgery.

Cited by 28 publications

References 33 publications

The Obesity Paradox

The Obesity Paradox

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

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