Cholesterol and serum albumin as risk factors for death in patients undergoing general surgery

BACKGROUND: Serum levels of total cholesterol, its fractions (high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol) and albumin are related to a poor outcome during hospital stay. It has been not assessed whether they are related to death in the long term after general surgery. METHODS: This prospective cohort study included 2848 general surgical patients with a median follow-up of 6 years after discharge from hospital. Sampling for biochemical measurements was done at the time of admission. The outcome investigated was all-cause mortality and multivariable Cox regression was used for statistical analysis. RESULTS: Three hundred and seventy-eight patients (13.3 per cent) died during follow-up. Serum albumin (adjusted hazard ratio (HR) 2.2 (95 per cent confidence interval (c.i.) 1.5 to 3.4) for lowest versus highest quintile), total cholesterol (HR 1.6 (95 per cent c.i. 1.1 to 2.3) for lowest versus highest quintile) and HDL-C (HR 1.6 (95 per cent c.i. 1.1 to 2.4) for lowest versus highest quintile) showed a significant inverse relationship with all-cause mortality in both crude and multivariable analyses. Serum albumin and HDL-C were associated with death for up to 2 years after surgery, whereas total cholesterol had the strongest association more than 2 years after discharge. CONCLUSION: Low levels of serum albumin, total cholesterol and HDL-C are associated with death after discharge from hospital in patients having general surgery.