Low circulatory cholesterol, high density lipoproteins-cholesterol, low density lipoproteins-cholesterol levels at intensive care unit admission: An underexplored predictor of mortality in critically ill patients

Objective: This study evaluated the relationship between serum cholesterol, HDL-C, and LDL-C at ICU admission and mortality among critically ill patients. Materials and Methods: A prospective observational study took place at the Department of Pathology, Quaid-e-Azam Medical College, from September 2023 to August 2024. Critically ill patients aged 18 years or older were included, with lipid profiles measured within 24 hours of ICU admission. Serum total cholesterol, HDL-C, LDL-C, inflammatory markers, and clinical parameters were analyzed. Statistical analysis was made between survivors and non-survivors using t-tests, chi-square tests, and correlation analyses. Correlations between lipid parameters (TC, HDL-C, LDL-C) and illness-severity/inflammatory markers (SOFA score and CRP) were examined using Spearman’s rank correlation. Results: Among 100 critically ill patients, survivors had significantly higher serum total cholesterol (129 ± 32.8 mg/dL vs. 83 ± 29.5 mg/dL), HDL-C (22.8 ± 3.28 mg/dL vs. 14.8 ± 2.79 mg/dL), and LDL-C (73.0 ± 17.37 mg/dL vs. 40.8 ± 19.2 mg/dL) than non-survivors (p < 0.001). Early mortality (≤7 days) was linked to lower serum lipid levels than late mortality (>7 days). Elevated serum CRP, higher SOFA scores, and prolonged ICU stays further correlated with poor outcomes. Conclusion: At ICU admission, low cholesterol, HDL-C, and LDL-C levels are strongly linked with increased mortality. Lipid profiling should be integrated into ICU risk stratification models to optimize patient management and improve outcomes. Keywords: Critical illness, Cholesterol, HDL-C, LDL-C, ICU mortality.