Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Second Department of Neurology, School of Medicine, National & Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
Atherosclerosis. 2018 Feb;269:14-20. doi: 10.1016/j.atherosclerosis.2017.12.008. Epub 2017 Dec 6.
The relationship between lipoprotein levels, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and clinical outcome after intracerebral hemorrhage (ICH) remains controversial. We sought to evaluate the association of lipoprotein cholesterol levels and statin dosage with clinical and neuroimaging outcomes in patients with ICH.
Data on consecutive patients hospitalized with spontaneous acute ICH was prospectively collected over a 5-year period and retrospectively analyzed. Demographic characteristics, clinical severity documented by NIHSS-score and ICH-score, neuroimaging parameters, pre-hospital statin use and doses, and LDL-C and HDL-C levels were recorded. Outcome events characterized were hematoma volume, hematoma expansion, in-hospital functional outcome, and in-hospital mortality.
A total of 672 patients with acute ICH [(mean age 61.6 ± 14.0 years, 43.6% women, median ICH score 1 (IQR: 0-2)] were evaluated. Statin pretreatment was not associated with neuroimaging or clinical outcomes. Higher LDL-C levels were associated with several markers of poor clinical outcome and in-hospital mortality. LDL-C levels were independently and negatively associated with the cubed root of hematoma volume (linear regression coefficient -0.021, 95% CI: -0.042--0.001; p = 0.049) on multiple linear regression models. Higher admission LDL-C (OR 0.88, 95% CI 0.77-0.99; p = 0.048) was also an independent predictor for decreased hematoma expansion. Higher admission LDL-C levels were independently (p < 0.001) associated with lower likelihood of in-hospital mortality (OR per 10 mg/dL increase 0.68, 95% CI: 0.57-0.80) in multivariable logistic regression models.
Higher LDL-C levels at hospital admission were an independent predictor for lower likelihood of hematoma expansion and decreased in-hospital mortality in patients with acute spontaneous ICH. This association requires independent confirmation.
脂蛋白水平、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）与脑出血（ICH）后临床转归之间的关系仍存在争议。我们旨在评估脂蛋白胆固醇水平和他汀类药物剂量与 ICH 患者临床和神经影像学结局的关系。
在 5 年期间前瞻性收集连续住院的自发性急性 ICH 患者的数据，并进行回顾性分析。记录人口统计学特征、NIHSS 评分和 ICH 评分记录的临床严重程度、神经影像学参数、院前他汀类药物使用和剂量以及 LDL-C 和 HDL-C 水平。描述的结局事件为血肿体积、血肿扩大、住院期间的功能结局和住院期间的死亡率。
共评估了 672 例急性 ICH 患者[（平均年龄 61.6±14.0 岁，43.6%为女性，ICH 评分中位数 1（IQR：0-2）]。他汀类药物预处理与神经影像学或临床结局无关。较高的 LDL-C 水平与多种不良临床结局和住院期间死亡率标志物相关。LDL-C 水平与血肿体积的立方根呈独立负相关（线性回归系数-0.021，95%CI：-0.042~-0.001；p=0.049），在多元线性回归模型中。较高的入院 LDL-C（OR 0.88，95%CI 0.77-0.99；p=0.048）也是血肿扩大减少的独立预测因子。较高的入院 LDL-C 水平与较低的住院期间死亡率独立相关（每增加 10mg/dL 的 OR 为 0.68，95%CI：0.57-0.80），在多变量逻辑回归模型中。
入院时较高的 LDL-C 水平是急性自发性 ICH 患者血肿扩大减少和住院期间死亡率降低的独立预测因子。这种关联需要独立确认。
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