Ailing Zhang1, Wenjing Deng2, Bin Zhang3, Mengyang Ren3, Long Tian3, Jihui Ge3, Jinjuan Bai3, Hao Hu3, Ling Cui3. 1. Department of Neurology, People's Hospital of Zhengzhou, Zhengzhou City, 450003, Henan Province, China. alz1201@163.com. 2. The Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, 450000, Henan Province, China. 3. Department of Neurology, People's Hospital of Zhengzhou, Zhengzhou City, 450003, Henan Province, China.
Abstract
BACKGROUND: Contribution of lipid profiles to stroke severity and outcome was inconclusive, whether chronic kidney disease (CKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) affects the association has not been investigated. We aim to evaluate this relationship. METHODS: A retrospective study of consecutive acute ischemic stroke patients was performed. We assessed the risk of severe stroke with the National Institutes of Health Stroke Scale (NIHSS) ≥ 5 at admission and poor outcome with the modified Rankin Scale (mRS) ≥ 3 at discharge. Multivariate stepwise logistic regression models were adopted to study interaction and independent association of lipid components with stroke severity and outcome according to lipid level quartiles by CKD stratification. RESULTS: Among the 875 included patients (mean age 64.9 years, 67.8% males), 213 (24.3%) presented with CKD. Elevated low-density lipoprotein cholesterol (LDL-C) was independently associated with severe stroke in patients with CKD (P for trend = 0.033) than in those without CKD (P for trend = 0.121). The association between the level of LDL-C and stroke severity was appreciably modified by CKD (Pinteraction = 0.013). Compared with without CKD patients in the lowest LDL-C quartile, the multivariable-adjusted risk of severe stroke increased significantly by 2.9-fold (95% CI 1.48-5.74) in patients with CKD in the highest LDL-C quartile. No significant association was observed between lipid components and early outcome in patients with and without CKD. CONCLUSION: LDL-C levels are positively associated with stroke severity in only patients with CKD, with an interactive impact of LDL-C and CKD on ischemic stroke in the acute phase.
BACKGROUND: Contribution of lipid profiles to stroke severity and outcome was inconclusive, whether chronic kidney disease (CKD) (estimated glomerular filtration rate < 60 mL/min/1.73 m2) affects the association has not been investigated. We aim to evaluate this relationship. METHODS: A retrospective study of consecutive acute ischemic strokepatients was performed. We assessed the risk of severe stroke with the National Institutes of Health Stroke Scale (NIHSS) ≥ 5 at admission and poor outcome with the modified Rankin Scale (mRS) ≥ 3 at discharge. Multivariate stepwise logistic regression models were adopted to study interaction and independent association of lipid components with stroke severity and outcome according to lipid level quartiles by CKD stratification. RESULTS: Among the 875 included patients (mean age 64.9 years, 67.8% males), 213 (24.3%) presented with CKD. Elevated low-density lipoprotein cholesterol (LDL-C) was independently associated with severe stroke in patients with CKD (P for trend = 0.033) than in those without CKD (P for trend = 0.121). The association between the level of LDL-C and stroke severity was appreciably modified by CKD (Pinteraction = 0.013). Compared with without CKD patients in the lowest LDL-C quartile, the multivariable-adjusted risk of severe stroke increased significantly by 2.9-fold (95% CI 1.48-5.74) in patients with CKD in the highest LDL-C quartile. No significant association was observed between lipid components and early outcome in patients with and without CKD. CONCLUSION:LDL-C levels are positively associated with stroke severity in only patients with CKD, with an interactive impact of LDL-C and CKD on ischemic stroke in the acute phase.
Authors: Charles J Ferro; Patrick B Mark; Mehmet Kanbay; Pantelis Sarafidis; Gunnar H Heine; Patrick Rossignol; Ziad A Massy; Francesca Mallamaci; Jose M Valdivielso; Jolanta Malyszko; Marianne C Verhaar; Robert Ekart; Raymond Vanholder; Gerard London; Alberto Ortiz; Carmine Zoccali Journal: Nat Rev Nephrol Date: 2018-12 Impact factor: 28.314