School of Medicine, New York Medical College, Valhalla, NY, 10595, USA.
Department of Neurosurgery, Oregon Health and Sciences University, Portland, OR, 97239, USA.
Clin Neurol Neurosurg. 2020 Oct;197:106062. doi: 10.1016/j.clineuro.2020.106062. Epub 2020 Jul 2.
Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH.
We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed.
There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm.
Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.
蛛网膜下腔出血（aSAH）具有破坏性，迟发性脑缺血（DCI）是导致高发病率和死亡率的主要原因。胆固醇已被研究作为衡量其他神经病理学中营养状况的指标，但有关胆固醇对 aSAH 结果影响的报道很少。本研究旨在阐明低总胆固醇（TC）和高密度脂蛋白（HDL）对 aSAH 后死亡率和 DCI 的影响。
我们在 2014 年 6 月至 2018 年 7 月期间在一家四级学术医疗中心进行了回顾性队列研究。所有患者均通过数字减影血管造影术确诊为 aSAH，并在入院时测量 TC。主要结局是死亡率和 DCI。次要结局是影像学血管痉挛。进行了单变量和多变量逻辑回归分析。
共纳入 75 例 aSAH 患者，平均年龄 58.7±1.7（范围：14-89），Hunt & Hess 评分 2.8±0.1。TC＜160mg/dL 的患者发生 DCI 的几率增加了 3 倍（OR=3.4；95%CI：1.3-9.0；p=0.0175），死亡几率增加了近 5 倍（OR=4.9；95%CI：1.1-18.3；p=0.0339）。低 HDL＜40mg/dL 与 DCI 的几率增加 12 倍相关（OR=12.3；95%CI：2.7-56.4；p=0.0003），但与死亡率无显著差异（p=0.2205）。多变量分析表明，低 TC 是增加死亡率的独立危险因素（OR=5.6；95%CI：1.2-27.6；p=0.0335），而低 HDL 与 DCI 的风险增加相关（OR=17.9；95%CI：3.1-104.4；p=0.0013）。TC 或 HDL 对影像学血管痉挛无影响。
低 TC 和 HDL 分别是 aSAH 后死亡率和 DCI 的独立预测因素。低 TC 和 HDL 可能不仅对脑血管具有某些病理生理作用，而且还可能是整体健康状况不佳的标志物。这些结果可能对改善 aSAH 的预后和管理具有实际意义。
