Key result
Admission cholesterol ≤3.0 mmol/L linked to ~388% greater risk of poor neurological outcome in refractory OHCA.
Why the study?
Although higher cholesterol is a coronary artery disease risk factor, smaller studies reported worse outcomes in sudden cardiac death patients with lower cholesterol levels, leaving cholesterol's prognostic role unclear.
Do lower on-admission cholesterol levels predict poor neurological outcomes in patients with refractory out-of-hospital cardiac arrest?
Observational (n=123)
Open-label (outcome assessors blinded to lipid results)
Web-based randomization system (for original trial)
No
Do lower on-admission cholesterol levels predict poor neurological outcomes in patients with refractory out-of-hospital cardiac arrest?
Lower total and non-HDL cholesterol levels on admission are independently associated with poorer neurological outcomes after refractory out-of-hospital cardiac arrest.
Lower admission cholesterol associated with poor neurological outcome in refractory OHCA; leaves open causality and need for prospective validation.
Higher cholesterol level is a risk factor of coronary artery disease, the major cause of sudden cardiac death (SCD). However, smaller studies observed worse outcomes in SCD patients having lower total and LDL-cholesterol levels. Therefore, the prognostic role of cholesterol itself in patients with SCD remains to be clarified. We aimed to assess the relationship of on-admission cholesterol level to the neurological outcome in a secondary analysis of the randomized Prague OHCA trial population (extracorporeal cardiopulmonary resuscitation (ECPR) vs. standard approach in refractory cardiac arrest). Of 256 included patients with refractory cardiac arrest, 123 were analyzed. The effects of total, HDL and non-HDL cholesterol levels drawn at admission on the best cerebral performance category (CPC) within 180 days were examined. Results are presented as median (interquartile range) and differences compared by the Wilcoxon test. Patients with CPC 1-2 had higher initial levels of total cholesterol [3.70 (3.23-4.27) mmol/L vs. 2.98 (2.35-4.02) mmol/L, p = 0.005], non-HDL cholesterol [2.68 (2.08-3.24) vs. 1.93 (1.62-2.97) mmol/L, p = 0.007 and HDL-cholesterol [0.93 (0.67-1.07) mmol/L vs. 0.74 (0.49-0.96) mmol/L, p = 0.014] compared to patients with CPC 3-5. Chronic use of statins did not influence the outcome. Only the low levels of total and non-HDL cholesterol remained consistent predictors of poor neurological outcomes in all patients and in both separate arms. Lower total and non-HDL cholesterol levels on admission are associated with worse neurological outcomes in patients with refractory cardiac arrest treated by both ECPR and standard approach.
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Malík et al. (2025) conducted an observational in Refractory out-of-hospital cardiac arrest (n=123). Total cholesterol ≤ 3.0 mmol/L vs. Total cholesterol > 3.0 mmol/L was evaluated on Poor neurological outcome (CPC 3-5) within 180 days (OR 4.88, 95% CI 2.19-10.9, p=0.0001). Total cholesterol levels ≤ 3.0 mmol/L on admission were associated with a significantly increased risk of poor neurological outcome compared to levels > 3.0 mmol/L in patients with refractory out-of-hospital cardiac arrest (OR 4.88).
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