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Review
. 2023 Feb 1;5(2):e0860.
doi: 10.1097/CCE.0000000000000860. eCollection 2023 Feb.

Association Between Hypocholesterolemia and Mortality in Critically Ill Patients With Sepsis: A Systematic Review and Meta-Analysis

Daniel A Hofmaenner  1   2 , Pietro Arina  1 , Anna Kleyman  1 , Lauren Page Black  3 , Reinaldo Salomao  4 , Sébastien Tanaka  5   6 , Faheem W Guirgis  3 , Nishkantha Arulkumaran  1 , Mervyn Singer  1
Affiliations
Review

Association Between Hypocholesterolemia and Mortality in Critically Ill Patients With Sepsis: A Systematic Review and Meta-Analysis

Daniel A Hofmaenner et al. Crit Care Explor. .

Abstract

To ascertain the association between cholesterol and triglyceride levels on ICU admission and mortality in patients with sepsis.

Data sources: Systematic review and meta-analysis of published studies on PubMed and Embase.

Study selection: All observational studies reporting ICU admission cholesterol and triglyceride levels in critically ill patients with sepsis were included. Authors were contacted for further data.

Data extraction: Eighteen observational studies were identified, including 1,283 patients with a crude overall mortality of 33.3%. Data were assessed using Revman (Version 5.1, Cochrane Collaboration, Oxford, United Kingdom) and presented as mean difference (MD) with 95% CIs, p values, and I 2 values.

Data synthesis: Admission levels of total cholesterol (17 studies, 1,204 patients; MD = 0.52 mmol/L [0.27-0.77 mmol/L]; p < 0.001; I 2 = 91%), high-density lipoprotein (HDL)-cholesterol (14 studies, 991 patients; MD = 0.08 mmol/L [0.01-0.15 mmol/L]; p = 0.02; I 2 = 61%), and low-density lipoprotein (LDL)-cholesterol (15 studies, 1,017 patients; MD = 0.18 mmol/L [0.04-0.32 mmol/L]; p = 0.01; I 2 = 71%) were significantly lower in eventual nonsurvivors compared with survivors. No association was seen between admission triglyceride levels and mortality (15 studies, 1,070 patients; MD = 0.00 mmol/L [-0.16 to 0.15 mmol/L]; p = -0.95; I 2 = 79%).

Conclusions: Mortality was associated with lower levels of total cholesterol, HDL-cholesterol, and LDL-cholesterol, but not triglyceride levels, in patients admitted to ICU with sepsis. The impact of cholesterol replacement on patient outcomes in sepsis, particularly in at-risk groups, merits investigation.

Keywords: cholesterol levels; intensive care unit; lipids; sepsis; triglycerides.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
PRISMA flowchart.
Figure 2.
Figure 2.
Comparison of total cholesterol, high-density lipoprotein (HDL)-cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglyceride levels in eventual survivors and nonsurvivors by study. Dotted lines represent normal laboratory ranges, where reported in the studies. Horizontal gray bars represent normal laboratory ranges of the author’s institution. All values are demonstrated as mean and sd.
Figure 3.
Figure 3.
Forest plot—total cholesterol by study. Forest plots representing observational studies and effects on lipid alterations. Horizontal bars represent 95% CIs.
Figure 4.
Figure 4.
Forest plot—high-density lipoprotein cholesterol by study. Forest plots representing observational studies and effects on lipid alterations. Horizontal bars represent 95% CIs.
Figure 5.
Figure 5.
Forest plot—low-density lipoprotein cholesterol by study. Forest plots representing observational studies and effects on lipid alterations. Horizontal bars represent 95% CIs.
Figure 6.
Figure 6.
Forest plot—triglycerides by study. Forest plots representing observational studies and effects on lipid alterations. Horizontal bars represent 95% CIs.
See this image and copyright information in PMC

References

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