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Low LDL-C/HDL-C Ratio is Associated with Poor Clinical Outcome After Intracerebral Hemorrhage: A Retrospective Analysis of Multicenter, Prospective Cohort Data in China

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An Invited Commentary to this article was published on 19 January 2024

Abstract

Background

The association between low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio and the clinical outcomes of acute intracranial hemorrhage (ICH) remains unclear. In this study, we attempt to investigate whether low LDL-C/HDL-C ratio is associated with poor clinical outcomes in patients with ICH.

Methods

The database was collected from a multicenter, prospective, observational cohort study, conducted in 13 hospitals in Beijing from January 2014 to September 2016. A total of 1,964 patients with ICH were initially screened in our database. Next, we selected patients with admission serum lipid information for retrospective analysis. Patients were categorized into four groups based on LDL-C/HDL-C ratio quartiles. The main outcomes were 30-day and 90-day poor functional outcome, which is defined as modified Rankin Scale score of 3 to 6, and 90-day all-cause death. Logistic regression was used to assess the association between LDL-C/HDL-C ratio and 30-day or 90-day poor functional outcome. Kaplan–Meier survival analysis and Cox regression were used to assess the association between LDL-C/HDL-C ratio and 90-day all-cause death. Restricted cubic splines were used to explore the nonlinear association between LDL-C/HDL-C ratio and the outcome of patients with ICH.

Results

A total of 491 patients with spontaneous ICH were finally enrolled in our study. The mean age was 57.6 years old, and 72.1% (357/491) were men. After adjustment for confounders, patients in the lowest LDL-C/HDL-C quartile (< 1.74) had a significantly higher risk of 30-day and 90-day poor functional outcome compared with those in the highest quartile (> 3.16; 30-day: adjusted odds ratio 3.61, 95% confidence interval 1.68–7.72; 90-day: adjusted odds ratio 2.82, 95% confidence interval 1.33–5.95). Restricted cubic splines depicted a nonlinear association between LDL-C/HDL-C ratio and 90-day poor functional outcomes, indicating LDL-C/HDL-C ratio of 3.1–3.5 was correlated with better 90-day functional outcome. However, no significant correlation was found between low LDL-C/HDL-C ratio and 90-day all-cause death.

Conclusions

Lower LDL-C/HDL-C ratio (< 1.74) is independently associated with an increased risk of poor functional outcome in patients with ICH. In the population of patients whom we studied, there is a nonlinear association between LDL-C/HDL-C ratio and 90-day poor functional outcome, and patients with an LDL-C/HDL-C ratio of 3.1 to 3.5 tend to have the lowest risk of 90-day poor functional outcome.

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Funding

The study was supported by National Natural Science Foundation of China (Grant No. 82371302), Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences (2019-I2M-5–029), National Key Research and Development Program of China (2018YFC1312200/ 2018YFC131224), Beijing Municipal Committee of Science and Technology (Z201100005620010), Beijing Natural Science Foundation (Z200016), Beijing key clinical specialty and Ministry of Science and Technology of the People’s Republic of China (National Key R&D Program of China, 2018YFC1705003). We thank all patients who participated in our study.

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Authors and Affiliations

  1. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, 119 West Road, South 4th Ring, Fengtai District, Beijing, People’s Republic of China

    Lei Wu, Anxin Wang, Kaijiang Kang, Xiaoli Zhang, Xingquan Zhao & Wenjuan Wang

  2. China National Clinical Research Center for Neurological Diseases, Capital Medical University, Beijing, People’s Republic of China

    Lei Wu, Anxin Wang, Kaijiang Kang, Xiaoli Zhang, Xingquan Zhao & Wenjuan Wang

  3. Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

    Kaijiang Kang & Xingquan Zhao

  4. Center of Stroke, Beijing Institute for Brain Disorders, Beijing, People’s Republic of China

    Xingquan Zhao

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  1. Lei Wu
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  2. Anxin Wang
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  4. Xiaoli Zhang
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Contributions

LW analyzed, interpreted the data, and drafted the original manuscript. KK analyzed and interpreted the data. AW and XZ conducted the statistical analyses. WW designed the research. XZ designed the research, and handled the funding and supervision. The final manuscript was approved by all authors.

Corresponding author

Correspondence to Wenjuan Wang.

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The authors report no conflict of interest in this work.

Ethical approval/informed consent

This study protocol was reviewed and approved by the Institutional Review Board of Beijing Tiantan Hospital, Capital Medical University, approval number KY2014-023–02. Written informed consents were obtained from all participants or their legal relatives for the publication of any potentially identifiable data or images included in this article.

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Wu, L., Wang, A., Kang, K. et al. Low LDL-C/HDL-C Ratio is Associated with Poor Clinical Outcome After Intracerebral Hemorrhage: A Retrospective Analysis of Multicenter, Prospective Cohort Data in China. Neurocrit Care (2023). https://doi.org/10.1007/s12028-023-01905-z

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