Hypocholesterolemia in older hospitalized patients
Hypocholesterolemia occurs in a variety of acute and chronic illnesses. Previous studies have shown that nursing home residents and patients in acute care hospitals who have serum cholesterol levels less than 120 mg per dL (3.10 mmol per L) are at increased risk of premature death. Noel and colleagues conducted a retrospective, case-control study to determine the clinical characteristics, lipoprotein abnormalities and outcomes of older hospitalized patients which hypocholesterolemia.
The study included 50 patients 65 years of age or older who had normal serum cholesterol levels (at least 160 mg per dL [4.15 mmol per L]) on admission to the hospital but low cholesterol levels (120 mg per dL [3.10 mmol per L] or less) during hospitalization. The medical records of 50 control patients matched for age and sex were also reviewed. The cholesterol levels of these patients remained normal during hospitalization. The authors also conducted a laboratory study of lipoprotein levels in 17 patients 65 years of age or older whose cholesterol levels were normal on admission to the hospital but fell to 120 mg per dL (3.10 mmol per L) or less during hospitalization.
After adjustment for age, albumin concentration, diagnosis and feeding status, patients with hypocholesterolemia were found to have significantly more complications, a longer hospital stay and a slightly greater likelihood of dying in the hospital than control subjects. Complications included infections, gastrointestinal bleeding, seizure, arrhythmias, myocardial infarction and respiratory arrest. Patients with hypocholesterolemia appeared to have multiple abnormalities in lipoprotein metabolism, similar to those found in patients with severe malnutrition.
The data suggest that the development of hypocholesterolemia after admission to the hospital may be a unique marker for poor prognosis in older hospitalized patients. (Journal of the American Geriatrics Society, May 1991, vol. 39, p. 455.)
COPYRIGHT 1991 American Academy of Family Physicians
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