PROGNOSTIC VALUE OF PROGRESSIVE DECREASE IN SERUM-CHOLESTEROL IN PREDICTING SURVIVAL IN CHILD-PUGH-C VIRAL CIRRHOSIS

Background: The identification of cirrhotic patients with low life exp ectancy is an open clinical problem. Hypocholesterolemia is frequently found in severe chronic hepatic insufficiency because the liver is th e most active site of cholesterol metabolism, but poor information is available on its precise prognostic value. We evaluated the prognostic role of hypocholesterolemia in patients with advanced liver cirrhosis . Methods: Serial serum cholesterol concentrations of 34 patients with virus-induced cirrhosis, from the first appearance of Child-Pugh clas s C to death, were considered. To compare survival functions, we estab lished three base-line cholesterol cut-off points (150, 125, and 100 m g/dl) and stratified patients into groups A and B, with base-line chol esterol levels lower and higher than each cut-off value, respectively. Results: Cholesterolemia decreased progressively in all patients. At the 100 mg/dl cut-off point all group-A patients died within 17 months , whereas 75% of group-B patients were alive at 24 months (P < 0.0001) . Moreover, cholesterolemia was significantly correlated with cholines terase, indirect bilirubin, and total bilirubin at entry time and imme diately before death. No correlation was observed between cholesterol and these variables when stratified for the Child-Pugh score. Conclusi ons: Base-line serum cholesterol levels lower than 100 mg/dl identify a subgroup of Child-C cirrhotic patients with high mortality risk with in a 2-year follow-up. The prognostic importance of cholesterolemia ma y also be deduced by the significant correlation with other well-estab lished indicators of survival.