Characterization of biochemical and clinical correlates of hypocholesterolemia after hepatectomy

(Abstract non richiesto per la pubblicazione dello articolo) Postoperative changes of plasma cholesterol have been assessed in 92 patients undergoing hepatectomy. In patients who recovered normally, cholesterol decreased at postoperative day 1 and 3, then trended toward preoperative values. In patients who developed complications or died cholesterol decreased more severely at postoperative day 3, then remained persistently low until recovery from the complication or death. Regression analysis showed that postoperative cholesterol level was simultaneously related at any time to preoperative cholesterol, number of resected liver segments, presence of liver cirrhosis, sepsis, decrease in albumin and in hematocrit (p<0.0001 for all). Cholestasis, when present, moderated the decrease in cholesterol related to the other factors (p<0.0001). The quantitative impact of each factor was assesed in multiple regressions which explained up to 73% of the variability of cholesterol. Persistence of severe hypocholesterolemia for more than 5 days was invariably associated with death. These results contribute to explain the mechanisms of development of severe hypocholesterolemia in acute illness, its value as a cumulative index of severity of disease and the patterns of correlation with death, and have important clinical implications for patient management.