Background: The low-density lipoprotein cholesterol (LDL-C) might be protective in patients with sepsis. We sought to characterize potential association of hyperlipidemia (HLP) vs no HLP with all-cause mortality among patients hospitalized for pneumonia.
Methods: This is a retrospective observational study. The initial cohort consisted of consecutive 8,553 adults hospitalized at a large academic center with a discharge diagnosis of pneumonia from 1996 through 2015, who were followed until death or end of the study period, August 17, 2017. We compared 28-day and long-term mortality among pneumonia patients with and with no hyperlipidemia (HLP). We, then, performed propensity-score matching to minimize the confounder bias from retrospective observational study design. Accordingly, we identified 1,879 pneumonia patients with concurrent HLP and propensity-score matched in a 1:1 ratio to 1,879 patients with no HLP accounting for measured co-variates on logistic regression analysis. Data were presented separately for unmatched and matched groups
Results: . Among 8,553 un-matched patients with pneumonia, concurrent HLP vs no HLP, was independently associated with lower mortality at 28 days (hazard ratio [HR] 0.52; 95% confidence interval [CI] 0.41 – 0.66) and at median follow-up of 3.9 years (HR 0.75; 95% 0.70 – 0.80). The risk difference in mortality persisted between 1,879 propensity-score matched pairs both at 28 days (HR 0.65; 95%, CI 0.49 – 0.86) and at median follow-up of 3.9 years (HR 0.88; 95%, CI 0.81 – 0.96). In sub-groups of patients with clinically measured LDL-C, graded inverse associations between LDL-C levels and mortality were found in both unmatched and matched cohorts.
Conclusions: Among hospitalized patients with pneumonia, a diagnosis of HLP is protective against both short- and long-term risk of death after adjustment to other major contributors to mortality in both unmatched and propensity-score matched cohorts. These findings should be further investigated.
