Total cholesterol, HDL-cholesterol, and risk of nosocomial infection: a prospective study in surgical patients.
OBJECTIVE
To study the relationship between serum high-density lipoprotein cholesterol (HDL-C), total serum cholesterol, and nosocomial infection in patients undergoing general surgery.


METHODS
Prospective cohort study, with an extended follow-up to 1 month after hospital discharge.


METHODS
The general surgery service of a tertiary hospital.


METHODS
Nosocomial infection, mainly surgical-site infection (SSI), urinary tract infection, respiratory tract infection (RTI), and bacteremia.


METHODS
1,267 surgery patients aged 10 to 92 years.


RESULTS
182 subjects acquired 194 nosocomial infections, a cumulative incidence of 14.5%; most (116, 62.3%) were postoperative wound infections. There was an increase in infection risk at low levels of HDL-C, and both low and high total cholesterol levels. After adjusting simultaneously for several confounders, including total cholesterol, low levels of HDL-C (< or = 20 mg/dL) yielded an odds ratio (OR) of 2.2 (95% confidence interval [CI95], 0.6-7.9) for SSI and an OR of 10.3 (CI95, 0.7-151.5) for RTI. Otherwise, no trend was observed between HDL-C levels and infection risk, and no increased risk of nosocomial infection was observed for HDL-C values in the range of 21 to 49 mg/dL. Serum cholesterol showed a U-shaped relationship with nosocomial infection risk. Both low levels (below 102 mg/dL) and high levels (above 290 mg/dL) of total cholesterol were associated with a higher risk of SSI (mainly those caused by gram-negative bacteria) and RTI in comparison with the reference group (139-261 mg/dL).


CONCLUSIONS
Serum HDL-C and total cholesterol seem to be associated with the risk of nosocomial infection in surgical patients.
Delgado-Rodríguez
M
M
Division of Preventive Medicine and Public Health, School of Medicine, University of Cantabria, Santander, Spain.
Medina-Cuadros
M
M
Martínez-Gallego
G
G
Sillero-Arenas
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002784:Cholesterol / Q000097:blood / Q000172:deficiency*; D008076:Cholesterol, HDL / Q000097:blood / Q000172:deficiency*; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors
D008076:Cholesterol, HDL; D002784:Cholesterol