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Severe persistent hypocholesterolemia after emergency gastrointestinal surgery predicts in-hospital mortality in critically ill patients with diffuse peritonitis

 Seung Hwan Lee  ;  Jin Young Lee  ;  Tae Hwa Hong  ;  Bo Ok Kim  ;  Yeon Ju Lee  ;  Jae Gil Lee 
 PLOS ONE, Vol.13(7) : e0200187, 2018 
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BACKGROUND: Plasma cholesterol acts as a negative acute phase reactant. Total cholesterol decreases after surgery and in various pathological conditions, including trauma, sepsis, burns, and liver dysfunction. This study aimed to determine whether hypocholesterolemia after emergency gastrointestinal (GI) surgery is associated with in-hospital mortality in patients with diffuse peritonitis. METHODS: The medical records of 926 critically ill patients who had undergone emergency GI surgery for diffuse peritonitis, between January 2007 and December 2015, were retrospectively analyzed. The integrated areas under the curve (iAUCs) were calculated to compare the predictive accuracy of total cholesterol values from postoperative days (PODs) 0, 1, 3, and 7. Cox proportional hazard regression modeling was performed for all possible predictors identified in the univariate and multivariable analyses. RESULTS: The total cholesterol level measured on POD 7 had the highest iAUC (0.7292; 95% confidence interval, 0.6696-0.7891) and was significantly better at predicting in-hospital mortality than measurements on other days. The optimal total cholesterol cut-off value for predicting in-hospital mortality was 61 mg/dL and was determined on POD 7. A Cox proportional hazard regression analysis revealed that a POD 7 total cholesterol level < 61 mg/dL was an independent predictor of in-hospital mortality after emergency GI surgery (hazard ratio, 3.961; 95% confidence interval, 1.786-8.784). CONCLUSION: Severe persistent hypocholesterolemia (<61 mg/dL) on POD 7 independently predicted in-hospital mortality, after emergency GI surgery, in critically ill patients with diffuse peritonitis.
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1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Lee, Seung Hwan(이승환) ORCID logo https://orcid.org/0000-0001-7325-8262
Lee, Jae Gil(이재길) ORCID logo https://orcid.org/0000-0002-1148-8035
Lee, Jin Young(이진영)
Hong, Tae Hwa(홍태화)
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