Low blood cholesterol increases infections and deaths in surgical patients

Over the past quarter of a century, we have striven for ever lower cholesterol levels; during the same period hospital-borne infections, such as MRSA and Clostridium difficile (C diff) and deaths from such infections have increased dramatically.

Studies into this problem have shown that low levels of blood cholesterol are compromise the immune system and lead to an increased susceptibility postoperative infections.[1] Low cholesterol also predicts death and adverse outcomes in hospitalised patients.[2]

A study of patients undergoing surgery for gastrointestinal diseases at the Universita di L'Aquila in Italy, found that 'Hypocholesterolemia [low blood cholesterol] seems to represent a significant predictive factor of morbidity and mortality in critically ill patients.'[3]

Of the patients studied, 35.1% contracted a postoperative infection. The highest number of postoperative septic complications (72.7%) was encountered in patients with cholesterol levels below 105 mg/dL (2.73 mmol/L). The authors say

'The results of this study seem to indicate a significant relationship between preoperative hypocholesterolemia and the incidence of septic complications after surgery. Moreover, evaluation of blood cholesterol levels before major surgery might represent a predictive factor of septic risk in the postoperative period.'

Another study conducted at the Department of Surgery, Weill Medical College of Cornell University, New York, found that lower levels of total cholesterol, and of LDL and HDL occurred early in the course of critical illness. This led to the development of a hospital infection. With or without the infection, lower cholesterol was independently associated with a higher death rate.[4] The authors conclude:

'Decreased serum cholesterol concentration is an independent predictor of mortality in critically ill surgical patients. Repletion of serum lipids is a feasible therapeutic approach for the management of critical illness.'

Many patients in hospitals have or acquire infections during or after major abdominal surgery.

The Department of Surgery at the Catholic University, Rome, Italy, conducted a study to identify factors that influenced mortality in patients who are affected by such infections.[5]

The hospital records of patients who had had a variety of abdominal operations and who had acquired an infection such as peritonitis were reviewed. Checking deaths against a battery of blood measurements, the authors of the study found that low cholesterol levels and low protein levels were both 'strongly and independently associated with the outcome'.

Dr Uffe Ravnskov found that:

'There is much evidence that blood lipids play a key role in the immune defence system. Bacterial endotoxin and Staphylococcus aureus a-toxin bind rapidly to and become inactivated by low-density-lipoprotein (LDL).'[6]
(Staphylococcus aureus is what the 'SA' in MRSA stands for.)

Ravnskov also pointed out that:
'Total cholesterol is inversely associated with mortality caused by respiratory and digestive disease, the aetiologies of which are mostly infectious. Total cholesterol is also inversely associated with the risk of being admitted to hospital because of an infectious disease.'
In other words, if you have low cholesterol, firstly, you are more likely to end up in hospital and, secondly, you are more likely to contract an infection while you are there.

1. Leardi S, Altilia F, Delmonaco S, et al. Blood levels of cholesterol and postoperative septic complications. Ann Ital Chir 2001; 71: 233-237.
2. Crook MA, Velauthar U, Moran L, Griffiths W. Hypocholesterolaemia in a hospital population. Ann Clin Biochem 1999; 36: 613-616.
3 Leardi S, Altilia F, Delmonaco S, et al. Blood levels of cholesterol and postoperative septic complications. Ann Ital Chir 2000; 71: 233-7.
4.Bonville DA, Parker TS, Levine DM, et al. The relationships of hypocholesterolemia to cytokine concentrations and mortality in critically ill patients with systemic inflammatory response syndrome. Surg Infect (Larchmt). 2004; 5: 39-49.
5. Pacelli F, Doglietto GB, Alfieri S, et al. Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg 1996; 131: 641-5.
6. Ravnskov U. High Cholesterol May Protect Against Infections and Atherosclerosis. Quart J Med 2003; 96: 927-34.

Part 1: Immunity | Part 2: Hospital Infections

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Last updated: December 9, 2011