Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China; National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100071, China.
Sci Bull (Beijing). 2023 Jun 30;68(12):1327-1335. doi: 10.1016/j.scib.2023.05.028. Epub 2023 May 23.
During the acute stage of ischemic stroke, it remains unclear how to interpret the low low-density lipoprotein cholesterol (LDL-C) level. We aimed to evaluate the association between LDL-C levels, post-stroke infection, and all-cause mortality. 804,855 ischemic stroke patients were included. Associations between LDL-C levels, infection, and mortality risk were estimated by multivariate logistic regression models and displayed by restricted cubic spline curves. Mediation analysis was performed under counterfactual framework to elucidate the mediation effect of post-stroke infection. The association between LDL-C and mortality risk was U-shaped. The nadir in LDL-C level with the lowest mortality risk was 2.67 mmol/L. Compared with the group with LDL-C = 2.50-2.99 mmol/L, the multivariable-adjusted odds ratio for mortality was 2.22 (95% confidence intervals (CI): 1.77-2.79) for LDL-C <1.0 mmol/L and 1.22 (95% CI: 0.98-1.50) for LDL-C ≥5.0 mmol/L. The association between LDL-C and all-cause mortality was 38.20% (95% CI: 5.96-70.45, P = 0.020) mediated by infection. After stepwise excluding patients with increasing numbers of cardiovascular risk factors, the U-shaped association between LDL-C and all-cause mortality and the mediation effects of infection remained consistent with the primary analysis, but the LDL-C interval with the lowest mortality risk increased progressively. The mediation effects of infection were largely consistent with the primary analysis in subgroups of age ≥65 years, female, body mass index <25 kg/m, and National Institutes of Health Stroke Scale ≥16. During the acute stage of ischemic stroke, there is a U-shaped association between LDL-C level and all-cause mortality, where post-stroke infection is an important mediating mechanism.
在缺血性脑卒中的急性期，对于低低密度脂蛋白胆固醇（LDL-C）水平的解读仍存在争议。本研究旨在评估 LDL-C 水平与卒中后感染和全因死亡率之间的关系。共纳入 804855 例缺血性脑卒中患者。采用多变量 logistic 回归模型评估 LDL-C 水平、感染与死亡风险之间的关系，并通过限制立方样条曲线展示。基于反事实框架进行中介分析，以阐明卒中后感染的中介作用。LDL-C 与死亡风险之间的关系呈 U 型。LDL-C 水平最低、死亡率最低的拐点为 2.67mmol/L。与 LDL-C=2.50-2.99mmol/L 组相比，LDL-C<1.0mmol/L 组和 LDL-C≥5.0mmol/L 组的全因死亡率校正后比值比分别为 2.22（95%可信区间：1.77-2.79）和 1.22（95%可信区间：0.98-1.50）。LDL-C 与全因死亡率之间的关系有 38.20%（95%可信区间：5.96-70.45，P=0.020）通过感染发生中介作用。逐步排除心血管危险因素数量不断增加的患者后，LDL-C 与全因死亡率之间的 U 型关联和感染的中介作用仍与主要分析一致，但死亡率最低的 LDL-C 间隔逐渐增加。感染的中介作用在年龄≥65 岁、女性、体重指数<25kg/m2 和美国国立卫生研究院卒中量表≥16 分的亚组中与主要分析基本一致。在缺血性脑卒中的急性期，LDL-C 水平与全因死亡率之间呈 U 型关系，卒中后感染是一个重要的中介机制。
