Prognostic Value of Decreased High-Density Lipoprotein Cholesterol Levels in Infective Endocarditis

Abstract

(1) Background: Simple parameters to be used as early predictors of prognosis in infective endocarditis (IE) are lacking. The aim of this study was to evaluate the prognostic role of high-density-lipoprotein cholesterol (HDL-C) and also of total-cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and triglycerides, in relation to clinical features and mortality, in IE. (2) Methods: Retrospective analysis of observational data from 127 consecutive patients with a definite diagnosis of IE between 2016 and 2019. Clinical, laboratory and echocardiography data, mortality, and co-morbidities were analyzed in relation to HDL-C and lipid profile. (3) Results: Lower HDL-C levels (p = 0.035) were independently associated with in-hospital mortality. HDL-C levels were also significantly lower in IE patients with embolic events (p = 0.036). Based on ROC curve analysis, a cut-off value was identified for HDL-C equal to 24.5 mg/dL for in-hospital mortality. HDL-C values below this cut-off were associated with higher triglyceride counts (p = 0.008), higher prevalence of S. aureus etiology (p = 0.046) and a higher in-hospital mortality rate (p = 0.004). Kaplan-Meier survival analysis showed higher 90-day mortality in patients with HDL-C ≤ 24.5 mg/dL (p = 0.001). (4) Conclusions: Low HDL-C levels could be used as an easy and low-cost marker of severity in IE, particularly to predict complications, in-hospital and 90-day mortality.

Keywords: HDL; hypolipidemia; infective endocarditis; mortality; prognosis.

Figure 1

Dot-plot graphs depicting the distribution of total cholesterol (a), LDL-C (b), and HDL-C (c) values in surviving and deceased patients and HDL-C distribution in patients with and without embolic events (d). HDL-C, high-density lipoprotein-cholesterol; LDL-C, low-density lipoprotein-cholesterol; TC, total cholesterol.

Figure 2

Panel (A): ROC curve analysis of the logistic regression model of HDL-C association with in-hospital mortality, adjusted for age and comorbidities (see Table 2). Area under the ROC curve: 0.804, 95% CI 0.698–0.910, p < 0.001). Panel (B): ROC curve analysis of HDL-C best cut-off for hospital mortality in IE. Area under the ROC curve: 0.743, 95% CI 0.628–0.857; p = 0.001).

Figure 3

Kaplan–Meier survival analysis at 90 days after hospital admission for IE. Red line indicates patients with HDL-C ≤ 24.5 mg/dL. Blue line denotes patients with HDL-C > 24.5 mg/dL.