Clinical paperThe association between lipid profiles and the neurologic outcome in patients with out-of-hospital cardiac arrest☆
Introduction
The lipid profiles usually include total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides. The lipid profile is known as a risk factor for atherosclerotic disease such as acute coronary syndrome.1 Since sudden cardiac death (SCD) accounts for one-half of all coronary heart disease-related deaths, several studies have reported on the association between lipid profile and risk of SCD.2, 3, 4 In a study including 139 out-of-hospital cardiac arrest (OHCA) patients, cholesterol, LDL, and non-HDL levels were lower in the SCD group than in the geographic control group.2 Jouven et al. reported that that high cholesterol level is associated with incidence of SCD.3
The association between lipid profiles and various pathologic conditions has also been investigated in several studies.5, 6, 7, 8, 9 Interestingly, in contrast to “the lower, the better” cholesterol hypothesis that has been generally accepted by many health care professionals, low cholesterol level was associated with poor prognosis in cancer,5 sepsis,6 and ischemic stroke.7 Additionally, in large cohort population-based study, high cholesterol level was associated with reduced all-cause mortality.8 This may be a clue that cholesterol contributes positively to the healing or recovery from pathologic conditions, apart from the characteristics of atherogenicity and contribution of coronary artery disease development. However, the relationship between lipid level and outcomes in OHCA survivors have been investigated only in a few studies.9
We hypothesized that dyslipidemia is associated with neurologic outcomes in OHCA survivors. Hence, in the present study, we aimed to investigate the association between serum lipid profiles and neurologic outcome in OHCA survivors. Furthermore, we aimed to examine the prognostic performance of lipid profile for neurologic outcome.
Section snippets
Study design and population
We performed a retrospective observational study of adult OHCA survivors admitted in Chonnam National University Hospital in Gwangju, Korea, from January 2016 to December 2018. We included OHCA patients aged over 18 years. Patients aged under 18 years, with no return of spontaneous circulation (ROSC) after cardiac arrest, who lacked lipid profile measurements 1 h after ROSC, and with missing data were excluded. The Institutional Review Board of Chonnam National University Hospital approved this
Characteristics of patients
A total of 524 OHCA patients were identified during the study period. Of them, 182 met the inclusion criteria as shown in Fig. 1. Supplementary Table 2 shows the results of comparison of characteristics between the excluded and included patients. There were significant differences between the included and excluded patients in terms of proportion of witnessed collapse; laboratory findings including the levels of lactate, glucose, and CK-MB; and time from ROSC to blood sampling. There was no
Discussion
In the present study, we found that the levels of total cholesterol and HDL after ROSC were associated with good neurologic outcomes at discharge in OHCA patients. In addition, the HDL level yielded fair performance in association with good neurologic outcomes.
HDL is well known as a “good” lipid and extensively investigated in several diseases and clinical conditions.13 It reduces inflammatory cytokine production such as tumor necrosis factor and neutralizing endotoxin toxicity in
Conclusion
The serum levels of total cholesterol and HDL within 1 h after ROSC were associated with good neurologic outcomes of patients with OHCA, without considering the effect of other lipid profiles simultaneously.
Conflicts of interest
All authors declare that they have no conflicts of interest.
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2020, Journal of Clinical Medicine
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Chonnam National University Hospital Institutional Review Board Protocol No. CNUH-2019-155.