Yuan Huai Wu, Yang Yi Na, Chen Han Feng, Ji Ren Jie, Lin Ya Jie, Guo Ren Yong, Peng Guo Ping, Liang Hui, Luo Benyan
Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Cerebrovasc Dis. 2020;49(1):88-96. doi: 10.1159/000505615. Epub 2020 Jan 29.
The statistical association between a short-term rise in low-density lipoprotein cholesterol (LDL-C) levels and the short-term outcome of acute ischemic stroke remains unknown. We aimed to evaluate the association in acute ischemic stroke patients during hospitalization.
Patients with acute ischemic stroke who received statin at discharge were enrolled in this multicenter registry study. LDL-C values were measured on the first day after admission and on the day before discharge to determine the rise in LDL-C levels. Poor outcome was defined as a modified Ranking Scale score ≥2 at discharge. The National Institutes of Health Stroke Scale increase from admission to discharge by 2 points was defined as clinical deterioration. Logistic regression analyses were used to analyze the relationship between LDL-C rise during hospitalization and poor outcome at discharge. Variables that were significantly different between the LDL-C rise and LDL-C fall groups were considered in adjustment for confounding variables in model 1. Age, sex, and those variables in model 1 were considered in adjustment for confounding variables in model 2.
Among the 676 patients, 110 (16.3%) showed a rise in LDL-C levels during hospitalization. Multivariate analyses showed that LDL-C at admission <1.6 mmol/L was significantly correlated with LDL-C rise during hospitalization (p < 0.001). There were significantly more patients with a poor outcome in the "LDL-C rise" group than in the "LDL-fall" group (p = 0.002). Multiple models consistently showed that LDL-C rise increased the risk of a poor outcome at discharge in model 1 (OR [95% CI] 1.351 [1.059-1.723], p = 0.016) and model 2 (OR [95% CI] 1.370 [1.071-1.751], p = 0.012). LDL-C rise also increased the risk of clinical deterioration, although its p value only was 0.043 in model 1 and 0.048 in model 2.
Rise in LDL-C during hospitalization from acute ischemic stroke is an independent predictor of poor outcome at discharge. In particular, patients with lower LDL-C values at admission are a higher at risk, and LDL-C in these patients should thus be monitored while in hospital.
低密度脂蛋白胆固醇（LDL-C）水平的短期升高与急性缺血性卒中的短期预后之间的统计学关联尚不清楚。我们旨在评估急性缺血性卒中患者住院期间的这种关联。
本多中心登记研究纳入了出院时接受他汀类药物治疗的急性缺血性卒中患者。在入院后第一天和出院前一天测量LDL-C值，以确定LDL-C水平的升高情况。不良预后定义为出院时改良Rankin量表评分≥2分。美国国立卫生研究院卒中量表从入院到出院增加2分定义为临床恶化。采用逻辑回归分析来分析住院期间LDL-C升高与出院时不良预后之间的关系。在模型1中对混杂变量进行调整时，考虑了LDL-C升高组和LDL-C降低组之间有显著差异的变量。在模型2中对混杂变量进行调整时，考虑了年龄、性别以及模型1中的那些变量。
在676例患者中，110例（16.3%）在住院期间LDL-C水平升高。多变量分析显示，入院时LDL-C<1.6 mmol/L与住院期间LDL-C升高显著相关（p<0.001）。“LDL-C升高”组中预后不良的患者明显多于“LDL-C降低”组（p = 0.002）。多个模型一致显示，在模型1中LDL-C升高增加了出院时不良预后的风险（OR[95%CI]1.351[1.059 - 1.723]，p = 0.016），在模型2中也是如此（OR[95%CI]1.370[1.071 - 1.751]，p = 0.012）。LDL-C升高也增加了临床恶化的风险，尽管其在模型1中的p值仅为0.043，在模型2中为0.048。
急性缺血性卒中住院期间LDL-C升高是出院时不良预后的独立预测因素。特别是，入院时LDL-C值较低的患者风险更高，因此应对这些患者住院期间的LDL-C进行监测。
