RESUMO
INTRODUCTION: Our primary objective was to determine the impact of traumatic injury, onset of infection, organ/metabolic dysfunction, and mortality on serum cholesterol. METHODS: During 676 surgical intensive care unit (SICU) days, 28 ventilated trauma patients underwent daily measurement of white blood cell (WBC) count and differential, cholesterol, arterial oxygen tension/fractional inspired oxygen, bilirubin, glucose, creatinine, and bicarbonate. With the onset of infection, WBC response was considered positive if the WBC count was 16.0 or greater, immature neutrophils were 10% or greater, or WBC count increased by 20%. Cholesterol response was considered positive if cholesterol decreased or failed to increase by 10%. RESULTS: Injury Severity Score was 30.6 +/- 8.6 and there were 48 infections. Initial cholesterol was decreased (119 +/- 44 mg/dl) compared with expected values from a database (201 +/- 17 mg/dl; P < 0.0001). The 25 survivors had higher cholesterol at SICU discharge (143 +/- 35 mg/dl) relative to admission (112 +/- 37 mg/dl; P < 0.0001). In the three patients who died, the admission cholesterol was 175 +/- 62 mg/dl and the cholesterol at death was 117 +/- 27 mg/dl. The change in percentage of expected cholesterol (observed value divided by expected value) from admission to discharge was different for patients surviving (16 +/- 19%) and dying (-29 +/- 19%; P = 0.0005). With onset of infection, the WBC response was positive in 61% and cholesterol response was positive in 91% (P = 0.001). Percentage of expected cholesterol was decreased with each system dysfunction: arterial oxygen tension/fractional inspired oxygen < 350, creatinine > 2.0 mg/dl, glucose > 120 mg/dl, bilirubin > 2.5 mg/dl, and bicarbonate >/= 28 or
