Prognostic Value of Decreased High-Density Lipoprotein Cholesterol Levels in Infective Endocarditis.

Rosa Zampino,Emanuele Durante-Mangoni,Giusi Cavezza,Fabian Patauner,Arta Karruli,Maria Paola Ursi,Anna Maria Peluso,Fabiana D’Amico,Domenico Iossa,Lorenzo Bertolino

doi:10.3390/jcm11040957

Rosa Zampino, Emanuele Durante-Mangoni + Show 8 more

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https://doi.org/10.3390/jcm11040957

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Abstract

(1) Background: Simple parameters to be used as early predictors of prognosis in infective endocarditis (IE) are lacking. The aim of this study was to evaluate the prognostic role of high-density-lipoprotein cholesterol (HDL-C) and also of total-cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and triglycerides, in relation to clinical features and mortality, in IE. (2) Methods: Retrospective analysis of observational data from 127 consecutive patients with a definite diagnosis of IE between 2016 and 2019. Clinical, laboratory and echocardiography data, mortality, and co-morbidities were analyzed in relation to HDL-C and lipid profile. (3) Results: Lower HDL-C levels (p = 0.035) were independently associated with in-hospital mortality. HDL-C levels were also significantly lower in IE patients with embolic events (p = 0.036). Based on ROC curve analysis, a cut-off value was identified for HDL-C equal to 24.5 mg/dL for in-hospital mortality. HDL-C values below this cut-off were associated with higher triglyceride counts (p = 0.008), higher prevalence of S. aureus etiology (p = 0.046) and a higher in-hospital mortality rate (p = 0.004). Kaplan–Meier survival analysis showed higher 90-day mortality in patients with HDL-C ≤ 24.5 mg/dL (p = 0.001). (4) Conclusions: Low HDL-C levels could be used as an easy and low-cost marker of severity in IE, particularly to predict complications, in-hospital and 90-day mortality.

Highlights

Infective endocarditis (IE) is a microbial disease affecting the endocardium, showing a high morbidity and mortality, ranging from 12% in native valve endocarditis (NVIE) to nearly 25% in prosthetic valve endocarditis (PVIE), and with a 1-year mortality >30% [1–3]
The aim of this study was to evaluate the prognostic role of highdensity-lipoprotein cholesterol (HDL-C) and of total-cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and triglycerides, in relation to clinical features and mortality, in infective endocarditis (IE). (2) Methods: Retrospective analysis of observational data from 127 consecutive patients with a definite diagnosis of IE between 2016 and 2019
166 IE patients were admitted to our center

Summary

Introduction

Infective endocarditis (IE) is a microbial disease affecting the endocardium, showing a high morbidity and mortality, ranging from 12% in native valve endocarditis (NVIE) to nearly 25% in prosthetic valve endocarditis (PVIE), and with a 1-year mortality >30% [1–3]. Lipid profiles are generally characterized by reductions in total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels and, often, by an increase in triglycerides [10]. This pattern has been observed in various infectious diseases and appears strongly linked to the severity of illness; it appears to be highest in sepsis with septic shock, where the inflammatory response to infection is more pronounced [10,13]. A condition of hypocholesterolemia, including reduction of TC, LDL-C and HDL-C, has been associated with a worse prognosis in patients with infection or sepsis [14–16] This form of hypolipidemia appeared to be superior compared to procalcitonin and C-reactive protein in predicting mortality in sepsis [17,18]

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