From the Research
Yes, low cholesterol is considered a sepsis biomarker, as supported by the most recent and highest quality study 1. During sepsis, cholesterol levels often decrease significantly due to several pathophysiological mechanisms. The inflammatory response in sepsis causes increased vascular permeability, leading to leakage of cholesterol-containing lipoproteins into the extravascular space. Additionally, sepsis triggers decreased hepatic synthesis of cholesterol and increased utilization of cholesterol for cell repair and steroid hormone production.
Key Findings
- Studies have shown that the degree of hypocholesterolemia (low cholesterol) correlates with sepsis severity and can predict mortality risk, as seen in a study published in the Journal of Intensive Care Medicine 2.
- A retrospective cohort study published in the Annals of Palliative Medicine found that both low and high serum total cholesterol concentrations were associated with higher mortality at 28 days in sepsis patients 3.
- A study published in Critical Care found that low LDL-C was associated with higher long-term rates of community-acquired sepsis, while HDL-C level was not associated with long-term sepsis rates 4.
- The most recent study published in Clinical and Translational Science found that lower measured HDL-C levels were significantly associated with increased risk of sepsis and related outcomes in patients with infection, but a causal relationship is unlikely because no association was found between the HDL-C PRS or the CETP PRS and the risk of adverse sepsis outcomes 1.
Clinical Implications
- Typically, total cholesterol levels below 100 mg/dL in a patient with suspected infection should raise concern for sepsis.
- This biomarker is particularly useful when tracked over time, as rapidly declining cholesterol levels may indicate worsening sepsis before other clinical signs become apparent.
- However, cholesterol levels should not be used in isolation but rather as part of a comprehensive assessment including other biomarkers like procalcitonin, C-reactive protein, and clinical parameters when evaluating for sepsis.