The post cardiac arrest syndrome (PCAS) is a sepsislike condition, that occurs in many patients as a reaction to the whole body ischemia during cardiac arrest (CA) and the reperfusion after return of sponateous circulation (ROSC). Part of the systemic inflammatory response syndrome (SIRS) seems to be caused by a pathologically increased gut permeability leading to a transmigration of enteric bacteria with consecutive toxinemia, for example lipopolysaccharide (LPS). LPS is bound and inactivated by lipoproteins due to amphiphatic components and internalised by hepatozytes via the receptor for low-density lipoprotein (LDLR). Patients who underwent cardiac surgery with aortocoronary bypass were less like to develop a postoperative sepsis, when they had higher preoperative cholesterol levels.
We conducted a retrospective data analysis of a registry to evaluate if serum cholesterol levels at admission can be associated with 30-day survival. The registry consisted of 1207 out of hospital cardiac arrest (OHCA) patients with non-traumatic origin aged over 18 years. In 1160 of those patients serum cholesterol levels at admission to the emergency department were documented. Normal distributed variables were analyzed by student’s T-Test, non-normal distributed variables were analyzed by Mann-Whitney-U-Test. We also adjusted for sex, age and BMI by using a binary-logistic regression model.
Patient who lived till day 30 showed to have had significantly higher serum cholesterol levels at admission (Median 168 mg/dl vs. 156 mg/dl, p=0.025). The odds ratio was 1,003 (1,000 – 1,006), even after adjustment for sex, age and BMI.
This retrospective data gives suggestion, that OHCA patients with higher serum cholesterol levels have higher odds for 30-day survival, like we can also see in patients, who undergo cardiac surgery with aortocoronary bypass. One possible reason could be, that higher cholesterol levels cause less sensitivity to transmigration of gramnegative bacteria as part of PCAS.