Serum cholesterol levels in neutropenic patients with fever

Hypocholesterolemia, which often accompanies infectious diseases
has been suggested to serve as a prognostic marker in hospitalized
patients. Even though patients with chemotherapyinduced leukopenia
are at high risk of infection and mortality, only limited
information is available on serum cholesterol levels in these
patients. We therefore measured serum cholesterol levels in 17
patients with hematological malignancies during chemotherapyinduced
neutropenia and correlated it with clinical outcome. Patients with
fever (>38.5 degreesC) showed a significant decrease in serum
cholesterol levels within 24 hours. Eight days after onset of the
fever nonsurvivors had significantly lower serum cholesterol levels
(median 2.09 mmol/l, range 0.492.79, n=6) compared to survivors
(median 3.23 mmol/l, range 1.684.86, n=11). Cholesterol levels in
survivors returned to baseline levels at the time of discharge from
the hospital. At the onset of fever, serum levels of inflammatory
cytokines interleukin-6, tumor necrosis factor (TNF) and soluble
TNF receptors p55 and p75 were elevated in all patients, but only
TNF and TNF receptor p75 levels were significantly different in
survivors and nonsurvivors. Our data suggest that a decrease in
serum cholesterol levels is a prognostic marker in neutropenic
patients with fever. Release of inflammatory cytokines may in part
be responsible for hypocholesterolemia in these patients.