title: High-density lipoprotein cholesterol as an indicator of liver function and prognosis in noncholestatic cirrhotics.
abstract: OBJECTIVE
  The liver plays a central role in production and degradation of lipoproteins. Declining lipoprotein cholesterol may reflect deteriorating liver function.
  
  
  METHODS
  We reviewed the records of 248 veterans with noncholestatic cirrhosis followed in our clinics or referred for liver transplantation between January 1, 1997 and October 31, 2002 (analysis period) and confirmed our findings prospectively in 165 noncholestatic cirrhotic veterans newly referred for liver transplantation between November 1, 2002 and May 1, 2004 (validation period).
  
  
  RESULTS
  In the analysis group, albumin, bilirubin, INR, and Model for End-Stage Liver Disease (MELD) score correlated strongly with high-density lipoprotein (HDL) cholesterol, weakly but significantly with total cholesterol and very-low-density lipoprotein cholesterol (VLDL), and poorly with low-density lipoprotein cholesterol (LDL). Transplant-free mortality at 90, 180, and 365 days was 17/201 (8.5%), 19/173 (11.0%), and 38/119 (31.9%), respectively. Death at all 3 time points was associated with significantly lower initial levels of HDL, VLDL, and total cholesterol, but not LDL cholesterol. Of the lipoproteins, HDL was the best predictor of survival at 180 and 365 days (concordance statistics .86+/-.05 and .78+/-.05, respectively). By multivariate logistic regression, HDL cholesterol and MELD score were independent predictors of survival at 6 and 12 months. By Cox regression, HDL cholesterol below 30 mg/dL was associated with 3.4-fold increase in the hazard ratio for cirrhotic death. In the validation period, HDL cholesterol was confirmed to be significantly associated with death or transplantation at 6 or 12 months.
  
  
  CONCLUSIONS
  HDL cholesterol in noncholestatic cirrhotic patients is a liver function test and an indicator of prognosis.
authors.affiliation: Department of Medicine, Virginia Commonwealth University Health Systems, Richmond, Virginia, USA.
authors.forename: Adil
authors.initials: A
authors.lastname: Habib
authors.forename: Anastasios A
authors.initials: AA
authors.lastname: Mihas
authors.forename: Souheil G
authors.initials: SG
authors.lastname: Abou-Assi
authors.forename: Leslie M
authors.initials: LM
authors.lastname: Williams
authors.forename: Edith
authors.initials: E
authors.lastname: Gavis
authors.forename: W Michael
authors.initials: WM
authors.lastname: Pandak
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Heuman
mesh_terms: D015415:Biomarkers; D002784:Cholesterol / Q000097:blood; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D008076:Cholesterol, HDL; D002784:Cholesterol