Hypocholesterolemia as a predictor of mortality in infective endocarditis

Infective endocarditis (IE) is a thrombo-inflammatory disorder affecting the endocardium, showing a high morbidity and mortality. Circulating cholesterol levels generally decrease in severe infections but have not been analyzed in depth in IE. This was a single-center retrospective observational study including IE patients admitted between 2016 and 2023. After drawing ROC curves of lipid profile components for mortality, variables of interest were compared among two subgroups, determined by the best predictor's cut-off value, using univariable and multivariable models. An adjusted logistic regression for in-hospital mortality was performed after inverse probability of treatment weighting. Survival analysis was carried out by the Kaplan-Meier method. Two-hundred-seventy-eight patients were included. Total cholesterol (TC) showed the highest AUROC for mortality (0.713 [0.625-0.801]). Patients with lower TC levels (≤ 134.5 mg/dL) were more likely to have ischemic heart disease (p = 0.026) and a higher creatinine (p = 0.006). Ischemic heart disease was an independent predictor of low TC levels (O.R. 2.190 [1.110-4.470]). The adjusted logistic regression showed a significantly higher risk of death during hospitalization in patients with lower TC levels (aOR 2.94, [1.80-4.92], p < 0.001). Survival analysis confirmed a higher in-hospital (p = 0.003) and 1-year (p < 0.001) mortality in patients with lower TC levels. Results of this study suggest that TC levels are strongly associated with in-hospital and 1-year mortality in IE. A cut-off for TC of 134.5 mg/dL was able to identify those at very low risk of death. Multicenter, prospective studies are needed to validate use of TC as a readily available and inexpensive marker of prognosis.