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Gennaro Nuzzo - One of the best experts on this subject based on the ideXlab platform.
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Severe Hypocholesterolemia in surgical patients, sepsis, and critical illness.
Journal of critical care, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Zdenek Zadak, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro Clemente, Marino Murazio, Gennaro NuzzoAbstract:After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of Hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of Hypocholesterolemia. In human sepsis, the poor implications of Hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.
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Hypocholesterolemia in critical illness.
Critical care medicine, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro NuzzoAbstract:No Abstract - The Letter discusses the issue of Hypocholesterolemia as a marker of severity of illness and a prognostic indicator in critically ill patients
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Characterization of biochemical and clinical correlates of Hypocholesterolemia after hepatectomy.
Clinical chemistry, 2003Co-Authors: Ivo Giovannini, Carlo Chiarla, Giuseppe Boldrini, Francesco Greco, Gennaro NuzzoAbstract:Although Hypocholesterolemia in posttraumatic states is considered a generic expression of acute-phase response, a relationship between severity of Hypocholesterolemia and bad prognosis has also been found (1)(2)(3)(4)(5)(6). The issue is still poorly understood and is complicated by the circumstance that plasma cholesterol is affected simultaneously by multiple factors whose impacts have never been distinctly characterized. The postoperative state after hepatectomy is an interesting condition in which most of these factors may be simultaneously present. We have assessed in detail the main biochemical and clinical correlates of Hypocholesterolemia in a large group of patients undergoing hepatectomy. Hepatectomies were performed in 92 patients (47 women, 45 men). The mean (± SD) age was 57 ± 12 years, body weight was 70 ± 11 kg, the ratio of actual to ideal body weight was 1.13 ± 0.16 (1983 Metropolitan Tables), body surface area was 1.78 ± 0.15 m2, and body mass index (weight/height2) was 25.0 ± 4.0 kg/m2. Thirty-six patients had primary liver malignancy (23 with hepatocarcinoma, 10 with cholangiocarcinoma, 3 with other neoplasms), 35 had secondary hepatic malignancies (23 from colorectal cancer, 12 from other sources), and 21 had benign lesions. Eighteen patients had liver cirrhosis. Fifty-four patients were in ASA class I (7), 7 in class II, 30 in class III, and 1 in class IV. No patient was on cholesterol-lowering medication. Hepatectomies consisted of 43 minor (
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Pathophysiologic correlates of Hypocholesterolemia in critically ill surgical patients
Intensive care medicine, 1999Co-Authors: Ivo Giovannini, Carlo Chiarla, Felice Giuliante, Maria Vellone, Giuseppe Boldrini, Gennaro NuzzoAbstract:To assess correlates of Hypocholesterolemia in moderate to critical surgical illness. Design: Prospective analysis of laboratory and clinical data. Setting: Department of surgery in a university hospital. Patients: 135 patients undergoing uncomplicated abdominal surgery or with sepsis, liver failure, hemorrhage, severe cholestasis, or multiple organ dysfunction syndrome (MODS). Interventions: Surgical and/or medical therapy according to clinical status. Measurements and main results: Determinations of total cholesterol, additional variables, and clinical data. Cholesterol decreased after surgery, in sepsis, liver failure, acute hemorrhage, and MODS and increased in cholestasis. Hypocholesterolemia correlated with decreases in plasma proteins and indices of hepatic protein synthetic adequacy, with hemodilution from blood loss, and was moderated or prevented by cholestasis. Conclusions: These results help to explain the dynamics of the development, clinical relevance, and negative prognostic value of Hypocholesterolemia in critical illness.
Ivo Giovannini - One of the best experts on this subject based on the ideXlab platform.
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Severe Hypocholesterolemia in surgical patients, sepsis, and critical illness.
Journal of critical care, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Zdenek Zadak, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro Clemente, Marino Murazio, Gennaro NuzzoAbstract:After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of Hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of Hypocholesterolemia. In human sepsis, the poor implications of Hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.
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Hypocholesterolemia in critical illness.
Critical care medicine, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro NuzzoAbstract:No Abstract - The Letter discusses the issue of Hypocholesterolemia as a marker of severity of illness and a prognostic indicator in critically ill patients
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Hypocholesterolemia in clinically serious conditions--review.
Biomedical papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia, 2008Co-Authors: P. Vyroubal, Carlo Chiarla, Ivo Giovannini, Radek Hyspler, Alena Ticha, Dana Hrnciarikova, Zdenek ZadakAbstract:BACKGROUND: Cholesterol is an essential component of cell membranes, precursor of steroids, biliary acids and other components of serious importance in live organism. Cholesterol synthesis is a complicated and energy-demanding process. Real daily need of cholesterol and mechanisms of decline cholesterol levels in critical ill are unknown. During stressful situations a significant hypocholesterolaemia may be found. Hypocholesterolemia has been known for a number of years to be a significant prognostic indicator of increased morbidity and mortality connected with a whole spectrum of pathological conditions. The aim of article is the elucidation of the role and importance of hypocholesterolaemia during the intensive care. METHODS AND RESULTS: We examined studies that are engaged in problems of Hypocholesterolemia in critically ill. Very low levels of total as well as LDL cholesterol are most frequently found in serious polytrauma, after extensive surgery, in serious infections, in protracted hypovolemic shock. It is still not clear whether Hypocholesterolemia reflects only a serious metabolic disorder, which results from a life-threatening condition, or whether it has an active role in evolution and outcome. CONCLUSIONS: Hypocholesterolemia is commonly observed in critically ill patients. Nevertheless, it is not known whether it is a secondary manifestation of disease, or whether it actively contributes to deterioration of the disease. Although the contribution of Hypocholesterolemia to mortality is modest compared with known risk factors such as increased severity of illness and the development of nosocomial infection, low serum lipid concentrations represent a potential therapeutic target in sepsis.
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Characterization of biochemical and clinical correlates of Hypocholesterolemia after hepatectomy.
Clinical chemistry, 2003Co-Authors: Ivo Giovannini, Carlo Chiarla, Giuseppe Boldrini, Francesco Greco, Gennaro NuzzoAbstract:Although Hypocholesterolemia in posttraumatic states is considered a generic expression of acute-phase response, a relationship between severity of Hypocholesterolemia and bad prognosis has also been found (1)(2)(3)(4)(5)(6). The issue is still poorly understood and is complicated by the circumstance that plasma cholesterol is affected simultaneously by multiple factors whose impacts have never been distinctly characterized. The postoperative state after hepatectomy is an interesting condition in which most of these factors may be simultaneously present. We have assessed in detail the main biochemical and clinical correlates of Hypocholesterolemia in a large group of patients undergoing hepatectomy. Hepatectomies were performed in 92 patients (47 women, 45 men). The mean (± SD) age was 57 ± 12 years, body weight was 70 ± 11 kg, the ratio of actual to ideal body weight was 1.13 ± 0.16 (1983 Metropolitan Tables), body surface area was 1.78 ± 0.15 m2, and body mass index (weight/height2) was 25.0 ± 4.0 kg/m2. Thirty-six patients had primary liver malignancy (23 with hepatocarcinoma, 10 with cholangiocarcinoma, 3 with other neoplasms), 35 had secondary hepatic malignancies (23 from colorectal cancer, 12 from other sources), and 21 had benign lesions. Eighteen patients had liver cirrhosis. Fifty-four patients were in ASA class I (7), 7 in class II, 30 in class III, and 1 in class IV. No patient was on cholesterol-lowering medication. Hepatectomies consisted of 43 minor (
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Pathophysiologic correlates of Hypocholesterolemia in critically ill surgical patients
Intensive care medicine, 1999Co-Authors: Ivo Giovannini, Carlo Chiarla, Felice Giuliante, Maria Vellone, Giuseppe Boldrini, Gennaro NuzzoAbstract:To assess correlates of Hypocholesterolemia in moderate to critical surgical illness. Design: Prospective analysis of laboratory and clinical data. Setting: Department of surgery in a university hospital. Patients: 135 patients undergoing uncomplicated abdominal surgery or with sepsis, liver failure, hemorrhage, severe cholestasis, or multiple organ dysfunction syndrome (MODS). Interventions: Surgical and/or medical therapy according to clinical status. Measurements and main results: Determinations of total cholesterol, additional variables, and clinical data. Cholesterol decreased after surgery, in sepsis, liver failure, acute hemorrhage, and MODS and increased in cholestasis. Hypocholesterolemia correlated with decreases in plasma proteins and indices of hepatic protein synthetic adequacy, with hemodilution from blood loss, and was moderated or prevented by cholestasis. Conclusions: These results help to explain the dynamics of the development, clinical relevance, and negative prognostic value of Hypocholesterolemia in critical illness.
Carlo Chiarla - One of the best experts on this subject based on the ideXlab platform.
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Severe Hypocholesterolemia in surgical patients, sepsis, and critical illness.
Journal of critical care, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Zdenek Zadak, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro Clemente, Marino Murazio, Gennaro NuzzoAbstract:After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of Hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of Hypocholesterolemia. In human sepsis, the poor implications of Hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.
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Hypocholesterolemia in critical illness.
Critical care medicine, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro NuzzoAbstract:No Abstract - The Letter discusses the issue of Hypocholesterolemia as a marker of severity of illness and a prognostic indicator in critically ill patients
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Hypocholesterolemia in clinically serious conditions--review.
Biomedical papers of the Medical Faculty of the University Palacky Olomouc Czechoslovakia, 2008Co-Authors: P. Vyroubal, Carlo Chiarla, Ivo Giovannini, Radek Hyspler, Alena Ticha, Dana Hrnciarikova, Zdenek ZadakAbstract:BACKGROUND: Cholesterol is an essential component of cell membranes, precursor of steroids, biliary acids and other components of serious importance in live organism. Cholesterol synthesis is a complicated and energy-demanding process. Real daily need of cholesterol and mechanisms of decline cholesterol levels in critical ill are unknown. During stressful situations a significant hypocholesterolaemia may be found. Hypocholesterolemia has been known for a number of years to be a significant prognostic indicator of increased morbidity and mortality connected with a whole spectrum of pathological conditions. The aim of article is the elucidation of the role and importance of hypocholesterolaemia during the intensive care. METHODS AND RESULTS: We examined studies that are engaged in problems of Hypocholesterolemia in critically ill. Very low levels of total as well as LDL cholesterol are most frequently found in serious polytrauma, after extensive surgery, in serious infections, in protracted hypovolemic shock. It is still not clear whether Hypocholesterolemia reflects only a serious metabolic disorder, which results from a life-threatening condition, or whether it has an active role in evolution and outcome. CONCLUSIONS: Hypocholesterolemia is commonly observed in critically ill patients. Nevertheless, it is not known whether it is a secondary manifestation of disease, or whether it actively contributes to deterioration of the disease. Although the contribution of Hypocholesterolemia to mortality is modest compared with known risk factors such as increased severity of illness and the development of nosocomial infection, low serum lipid concentrations represent a potential therapeutic target in sepsis.
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Characterization of biochemical and clinical correlates of Hypocholesterolemia after hepatectomy.
Clinical chemistry, 2003Co-Authors: Ivo Giovannini, Carlo Chiarla, Giuseppe Boldrini, Francesco Greco, Gennaro NuzzoAbstract:Although Hypocholesterolemia in posttraumatic states is considered a generic expression of acute-phase response, a relationship between severity of Hypocholesterolemia and bad prognosis has also been found (1)(2)(3)(4)(5)(6). The issue is still poorly understood and is complicated by the circumstance that plasma cholesterol is affected simultaneously by multiple factors whose impacts have never been distinctly characterized. The postoperative state after hepatectomy is an interesting condition in which most of these factors may be simultaneously present. We have assessed in detail the main biochemical and clinical correlates of Hypocholesterolemia in a large group of patients undergoing hepatectomy. Hepatectomies were performed in 92 patients (47 women, 45 men). The mean (± SD) age was 57 ± 12 years, body weight was 70 ± 11 kg, the ratio of actual to ideal body weight was 1.13 ± 0.16 (1983 Metropolitan Tables), body surface area was 1.78 ± 0.15 m2, and body mass index (weight/height2) was 25.0 ± 4.0 kg/m2. Thirty-six patients had primary liver malignancy (23 with hepatocarcinoma, 10 with cholangiocarcinoma, 3 with other neoplasms), 35 had secondary hepatic malignancies (23 from colorectal cancer, 12 from other sources), and 21 had benign lesions. Eighteen patients had liver cirrhosis. Fifty-four patients were in ASA class I (7), 7 in class II, 30 in class III, and 1 in class IV. No patient was on cholesterol-lowering medication. Hepatectomies consisted of 43 minor (
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Pathophysiologic correlates of Hypocholesterolemia in critically ill surgical patients
Intensive care medicine, 1999Co-Authors: Ivo Giovannini, Carlo Chiarla, Felice Giuliante, Maria Vellone, Giuseppe Boldrini, Gennaro NuzzoAbstract:To assess correlates of Hypocholesterolemia in moderate to critical surgical illness. Design: Prospective analysis of laboratory and clinical data. Setting: Department of surgery in a university hospital. Patients: 135 patients undergoing uncomplicated abdominal surgery or with sepsis, liver failure, hemorrhage, severe cholestasis, or multiple organ dysfunction syndrome (MODS). Interventions: Surgical and/or medical therapy according to clinical status. Measurements and main results: Determinations of total cholesterol, additional variables, and clinical data. Cholesterol decreased after surgery, in sepsis, liver failure, acute hemorrhage, and MODS and increased in cholestasis. Hypocholesterolemia correlated with decreases in plasma proteins and indices of hepatic protein synthetic adequacy, with hemodilution from blood loss, and was moderated or prevented by cholestasis. Conclusions: These results help to explain the dynamics of the development, clinical relevance, and negative prognostic value of Hypocholesterolemia in critical illness.
Menno Hoekstra - One of the best experts on this subject based on the ideXlab platform.
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Simvastatin treatment aggravates the glucocorticoid insufficiency associated with Hypocholesterolemia in mice
Atherosclerosis, 2017Co-Authors: Amber B. Ouweneel, Ronald J. Van Der Sluis, Joya E. Nahon, Miranda Van Eck, Menno HoekstraAbstract:Abstract Background and aims Statin treatment disrupts HMG-CoA reductase-mediated endogenous cholesterol synthesis and lowers plasma LDL-cholesterol levels. Although statin treatment can theoretically impair adrenal steroid hormone synthesis, thus far, no effect on glucocorticoid output has been described, as LDL-cholesterol levels usually remain within the physiological range. However, novel statin-based treatment regimens that dramatically decrease LDL-cholesterol levels are currently employed. Here, we assessed whether inhibition of cholesterol synthesis under these relatively hypocholesterolemic conditions may alter adrenal glucocorticoid output. Methods Hypocholesterolemic apolipoprotein A1 ( apoA1 ) knockout mice were administered high dose simvastatin twice daily for 3 days. Results Simvastatin treatment did not change plasma cholesterol levels or modify the adrenal expression levels of genes involved in cholesterol metabolism. However, simvastatin treatment lowered basal plasma levels of the primary glucocorticoid corticosterone (−62%; p apoA1 knockout mice already showed only a mild increase in plasma corticosterone levels, indicative of relative glucocorticoid insufficiency. Importantly, simvastatin treatment further diminished the adrenal glucocorticoid response to adrenocorticotropic hormone exposure (two-way ANOVA p p Conclusions We have shown that simvastatin treatment aggravates the glucocorticoid insufficiency associated with Hypocholesterolemia in mice. Our data suggest that (1) HMG-CoA reductase activity controls the adrenal steroidogenic capacity under hypocholesterolemic conditions and (2) imply that it might be important to monitor adrenal function in humans subjected to statin-based treatments aimed at achieving sub-physiological LDL-cholesterol levels, as these may potentially execute a negative impact on the glucocorticoid function in humans.
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Coexistence of Foam Cells and Hypocholesterolemia in Mice Lacking the ABC Transporters A1 and G1
Circulation Research, 2007Co-Authors: Wendy Jessup, Ingrid C Gelissen, Wilfried Le Goff, Leonard Kritharides, Giovanna Chimini, Menno Hoekstra, Johan Kuiper, Ying Zhao, M. John ChapmanAbstract:The concept that macrophages can become foam cells as a result of a disturbed balance between the uptake of cholesterol from lipoproteins and cholesterol efflux is generally accepted. ABCA1 and ABCG1 are two cholesterol transporters that may act sequentially to remove cellular cholesterol, but currently their combined role in vivo is unknown. We report here that targeted disruption of both ABCA1 and ABCG1 in mice, despite severe plasma Hypocholesterolemia, leads to massive lipid accumulation and foam cell formation of tissue macrophages. A complete ablation of cellular cholesterol efflux in vitro is observed, whereas in vivo macrophage-specific reverse cholesterol transport to the feces is markedly decreased. Despite the massive foam cell formation of tissue macrophages, no lipid accumulation was observed in the vascular wall, even in mice of 1 year old, indicating that the double knockout mice, possibly because of their Hypocholesterolemia, lack the trigger to attract macrophages to the vessel wall. In conclusion, even under hypocholesterolemic conditions macrophages can be converted into foam cells, and ABCA1 and ABCG1 play an essential role in the prevention of foam cell formation.
Felice Giuliante - One of the best experts on this subject based on the ideXlab platform.
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Severe Hypocholesterolemia in surgical patients, sepsis, and critical illness.
Journal of critical care, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Zdenek Zadak, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro Clemente, Marino Murazio, Gennaro NuzzoAbstract:After surgery, in sepsis and various critical illnesses, factors such as severity of the acute phase response, liver dysfunction, and hemodilution from blood loss have cumulative impacts in decreasing cholesterol; therefore, degree of Hypocholesterolemia often reflects severity of illness. The direct correlation between cholesterol and several plasma proteins is mediated by the parallel impact of commonly shared determinants. Cholestasis is associated with a moderation of the degree of Hypocholesterolemia. In human sepsis, the poor implications of Hypocholesterolemia seem to be aggravated by the simultaneous development of hypertriglyceridemia. Cholesterol and triglyceride levels reflect altered lipoprotein patterns, and the issue is too complex and too poorly understood to be reduced to simple concepts; nevertheless, these simple measurements often represent helpful adjunctive clinical tools.
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Hypocholesterolemia in critical illness.
Critical care medicine, 2009Co-Authors: Carlo Chiarla, Ivo Giovannini, Felice Giuliante, Maria Vellone, Francesco Ardito, Gennaro NuzzoAbstract:No Abstract - The Letter discusses the issue of Hypocholesterolemia as a marker of severity of illness and a prognostic indicator in critically ill patients
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Pathophysiologic correlates of Hypocholesterolemia in critically ill surgical patients
Intensive care medicine, 1999Co-Authors: Ivo Giovannini, Carlo Chiarla, Felice Giuliante, Maria Vellone, Giuseppe Boldrini, Gennaro NuzzoAbstract:To assess correlates of Hypocholesterolemia in moderate to critical surgical illness. Design: Prospective analysis of laboratory and clinical data. Setting: Department of surgery in a university hospital. Patients: 135 patients undergoing uncomplicated abdominal surgery or with sepsis, liver failure, hemorrhage, severe cholestasis, or multiple organ dysfunction syndrome (MODS). Interventions: Surgical and/or medical therapy according to clinical status. Measurements and main results: Determinations of total cholesterol, additional variables, and clinical data. Cholesterol decreased after surgery, in sepsis, liver failure, acute hemorrhage, and MODS and increased in cholestasis. Hypocholesterolemia correlated with decreases in plasma proteins and indices of hepatic protein synthetic adequacy, with hemodilution from blood loss, and was moderated or prevented by cholestasis. Conclusions: These results help to explain the dynamics of the development, clinical relevance, and negative prognostic value of Hypocholesterolemia in critical illness.