title: Low preoperative cholesterol level is a risk factor of sepsis and poor clinical outcome in patients undergoing cardiac surgery with cardiopulmonary bypass.
abstract: OBJECTIVE
  Systemic inflammatory response syndrome and sepsis frequently occur after cardiac surgery with cardiopulmonary bypass. The aim of the present study was to investigate whether preoperative cholesterol levels can predict sepsis onset and postoperative complications in patients undergoing cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Surgical ICU of a French university hospital.
  
  
  METHODS
  Two hundred and seventeen consecutive patients older than 18 years admitted for planned cardiac surgery with cardiopulmonary bypass.
  
  
  METHODS
  Measurements of plasma blood lipids and inflammation markers before anesthesia induction (baseline), at cardiopulmonary bypass start, at cardiopulmonary bypass end, and 3 and 24 hours after cardiac surgery. Outcomes were compared in systemic inflammatory response syndrome patients with sepsis (n = 15), systemic inflammatory response syndrome patients without sepsis (n = 95), and non-systemic inflammatory response syndrome patients (n = 107).
  
  
  RESULTS
  A gradual decrease in plasma cholesterol concentration occurred during surgery with cardiopulmonary bypass but was no longer present after correction for hemodilution. Corrected cholesterol levels were significantly lower at baseline in sepsis patients than in other subgroups, and it remained lower in the sepsis group during and after cardiopulmonary bypass. With regard to sepsis, the discriminatory power of baseline cholesterol was fairly good as indicated by receiver operating characteristic curve analysis (area under the curve, 0.78; 95% CI, 0.72-0.84). The frequency of sepsis progressively decreased with increasing baseline cholesterol level quintiles (18.6% and 0% in the bottom and top quintiles, respectively, p = 0.005). In multivariate analysis, baseline cholesterol levels and cardiopulmonary bypass duration were significant and independent determinants of the 3-hour postcardiopulmonary bypass increase in concentrations of procalcitonin and interleukin-8, but not of interleukin-6.
  
  
  CONCLUSIONS
  Low cholesterol levels before elective cardiac surgery with cardiopulmonary bypass may be a simple biomarker for the early identification of patients with a high risk of sepsis.
authors.affiliation: 1INSERM Research Center UMR866, University of Burgundy, Dijon, France. 2Department of Anaesthesia-Reanimation, University Hospital of Dijon, Dijon, France. 3INSERM CIE1, Clinical Investigation Center-Clinical Epidemiology, Dijon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Lagrost
authors.forename: Claude
authors.initials: C
authors.lastname: Girard
authors.forename: Sandrine
authors.initials: S
authors.lastname: Grosjean
authors.forename: David
authors.initials: D
authors.lastname: Masson
authors.forename: Valérie
authors.initials: V
authors.lastname: Deckert
authors.forename: Thomas
authors.initials: T
authors.lastname: Gautier
authors.forename: Frédérique
authors.initials: F
authors.lastname: Debomy
authors.forename: Sandrine
authors.initials: S
authors.lastname: Vinault
authors.forename: Aline
authors.initials: A
authors.lastname: Jeannin
authors.forename: Jérôme
authors.initials: J
authors.lastname: Labbé
authors.forename: Claire
authors.initials: C
authors.lastname: Bonithon-Kopp
mesh_terms: D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis; D002116:Calcitonin / Q000032:analysis; D015740:Calcitonin Gene-Related Peptide; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D002784:Cholesterol / Q000097:blood*; D003422:Critical Care; D016207:Cytokines / Q000032:analysis; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D008074:Lipoproteins / Q000032:analysis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D011498:Protein Precursors / Q000032:analysis; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis / Q000209:etiology*; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; C000606589:CALCA protein, human; D016207:Cytokines; D008074:Lipoproteins; D011498:Protein Precursors; D002116:Calcitonin; D002784:Cholesterol; D015740:Calcitonin Gene-Related Peptide