Abstract
BackgroundDespite a large body of studies have demonstrated the multifaceted behavior of high-density lipoproteins (HDLs) in several physiological and pathological processes, the levels of plasma HDL-cholesterol (HDL-C) that may be associated with endobronchial biopsy (EBB)-related bleeding have never been examined.MethodsWe conducted a single-center retrospective cohort study of 628 consecutive patients with primary lung cancer who had undergone EBB at a large tertiary hospital between January 2014 and February 2018. Patients were divided into the bleeding group and the non-bleeding group according to the bronchoscopy report. The association between HDL-C levels and EBB-induced bleeding was evaluated using the LASSO regression analysis, multiple regression analysis and smooth curve fitting adjusted for potential confounders.ResultsThere was an inverse association of plasma HDL-C concentration with the incidence of EBB-induced bleeding as assessed by univariate analysis (P < 0.05). However, in piecewise linear regression analysis, a non-linear relationship with threshold saturation effects was observed between plasma HDL-C concentrations and EBB-induced bleeding. The incidence of EBB-induced bleeding decreased with HDL-C concentrations from 1.5 mmol/L up to 2.0 mmol/L (adjusted OR, 0.39; 95% CI, 0.20–0.74), but increased with HDL-C levels above the inflection point (HDL-C = 2.0 mmol/L).ConclusionsThere was a non-linear association between plasma HDL-C concentrations and the risk of EBB-induced bleeding in patients with lung cancer. The plasma level of HDL-C above 2.0 mmol/L or below 1.5 mmol/L may increase the risk of EBB-induced bleeding.
Highlights
Despite a large body of studies have demonstrated the multifaceted behavior of high-density lipoproteins (HDLs) in several physiological and pathological processes, the levels of plasma HDL-cholesterol (HDLC) that may be associated with endobronchial biopsy (EBB)-related bleeding have never been examined
Based on non-zero coefficients in the least absolute shrinkage and selection operator (LASSO) regression analysis (Fig. 1), seven variables were filtered. These variables were high density lipoprotein cholesterol (HDL-C) (− 0.0527), activated partial thromboplastin time (APTT) (− 0.0146), neutrophils (0.0024), C-reactive protein (CRP) (0.0015), lesion location (0.6728), TNM stage (− 0.3905) and histological types (− 0.4902), among which the absolute value of coefficient of HDL-C was the maximum in all blood variables, suggesting that HDL-C has a stronger association with EBB-induced bleeding
We found that middle concentrations of HDL-C (1.5–2.0 mmol/L) associated with a decreased risk of EBB-induced bleeding when compared to lower concentrations (< 1.5 mmol/L)
Summary
Despite a large body of studies have demonstrated the multifaceted behavior of high-density lipoproteins (HDLs) in several physiological and pathological processes, the levels of plasma HDL-cholesterol (HDLC) that may be associated with endobronchial biopsy (EBB)-related bleeding have never been examined. Endobronchial biopsy (EBB), one of the most widely used transbronchial biopsy modalities, has been used in the diagnosis of pulmonary disease for more than 40. With regard to risk factors for bleeding during bronchoscopy, mechanical ventilation, immunosuppressive state, thrombocytopenia or anti-platelet therapy, anti-coagulant drugs use, liver and kidney disorders, heart function failure, and severe pulmonary arterial hypertension were proposed by several studies [6,7,8]. Whether these factors are in reality associated with bleeding during EBB, remain controversial [9, 10]. Most individuals who are subjected to EBB do not have the aforementioned factors in clinical practice.
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