Association of serum lipids with clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis

Deng, Qiwen; Li, Shuo; Zhang, Hanqing; Wang, Huan; Gu, Zhen; Zuo, Lei; Wang, Lvyue; Yan, Fuling

doi:10.1016/j.jocn.2018.09.003

Cited by 17 publications

(20 citation statements)

References 34 publications

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“…Under experimental stroke conditions, hyperglycemia promotes tissue acidosis, the production of reactive oxygen and nitrogen species, inflammatory cell infiltration, and the imbalance of matrix metalloprotease-9 that increase infarct size, brain swelling, hemorrhagic transformation, blood-brain barrier disruption and results in more severe neurological deficits (26,29). A number of studies have indicated that hypertriglyceridemia is associated with early neurological deterioration and mortality in patients with stroke (30). Hypertriglyceridemia is related to the development of atherosclerosis and the loss of reserve capacity of cerebral vessels (31).…”

Section: Discussionmentioning

confidence: 99%

Triglyceride-Glucose Index Linked to Hospital Mortality in Critically Ill Stroke: An Observational Multicentre Study on eICU Database

et al. 2020

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The triglyceride-glucose (TyG) index is a reliable surrogate of insulin resistance and a marker for ischemic stroke (IS) incident. Whether the TyG index predicts stroke outcome remains uncertain. This study investigated the prognostic value of the TyG index in critically ill stroke patients. Methods: This was a retrospective observational study that included stroke patients, and all data were extracted from the eICU Collaborative Research Database. The TyG index was calculated as the ln [fasting glucose level (mg/dL) × triglyceride level (mg/dL)/2]. Outcomes included the hospital and intensive care unit (ICU) death. Multivariate logistic regression was used to determine independent risk factors. The smoothing curves and forest plots were illustrated. Results: A total of 4,570 eligible subjects were enrolled. The mean level of TyG index was 9.1 ± 0.7. The hospital and ICU mortality rate were 10.3 and 5.0%, respectively. TyG index as a continuous variable was associated hospital mortality in univariate analysis (OR 1.723, 95% CI 1.524-1.948, P < 0.001), adjusted model 1 (OR 1.861, 95% CI 1637-2.116, P < 0.001), and adjusted model 2 (OR 2.543, 95% CI 1.588-4.073, P < 0.001). TyG was also associated ICU mortality in univariate analysis (OR 2.146, 95% CI 1.826-2.523, P < 0.001), adjusted model 1 (OR 2.183, 95% CI 1.847-2.580, P < 0.001), and adjusted model 2 (OR 2.672, 95% CI 1.376-5.188, P < 0.001). The smoothing curves observed a continuous linear association after adjusting all covariates both in hospital and ICU mortality. Subgroup analysis demonstrated TyG index was associated with increased risk of hospital and ICU death in critically ill IS (P < 0.05), but not in hemorrhage stroke (P > 0.05). Conclusion: The TyG index is a potential predictor for hospital and ICU mortality in critically ill stroke patients, especially in IS patients.

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Section: Discussionmentioning

confidence: 99%

Triglyceride-Glucose Index Linked to Hospital Mortality in Critically Ill Stroke: An Observational Multicentre Study on eICU Database

et al. 2020

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“…Several studies have reported that low levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) increase the incidence of cerebral hemorrhage [8] and HT after AIS [9,10], while others have observed no association between cholesterol level and HT [11,12]. Our prior studies have shown that low values of triglyceride (TG) and TG/high-density lipoprotein cholesterol (HDL-C) are independently associated with mortality and poor outcome in AIS patients [13–15]. Nevertheless, whether low levels of TG/HDL-C can increase the incidence of HT after AIS remains elusive.…”

Section: Introductionmentioning

confidence: 99%

Low triglyceride to high-density lipoprotein cholesterol ratio predicts hemorrhagic transformation in large atherosclerotic infarction of acute ischemic stroke

Deng

Liu

Zhang

et al. 2019

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The ratio of triglyceride (TG) to high-density lipoprotein cholesterol (HDL-C) is an objective approach to predicting poor outcomes in acute ischemic stroke (AIS). The impact of TG/HDL-C on hemorrhagic transformation (HT) after AIS remains unknown. The aim of this study was to explore the accurate effect of TG/HDL-C on HT after AIS. We enrolled a total of 1423 patients with AIS in the training cohort from a prospective, consecutive hospital-based stroke registry. Of the 1423 patients, HT occurred in 155 (10.89%) patients. The incidence of HT after AIS was significantly increased when there were low levels of TG (P=0.016) and TG/HDL-C (P=0.006) in patients with AIS attributable to large artery atherosclerosis (LAA), but not in those who suffered from cardioembolic stroke. After adjustment for covariates, a lower TG/HDL-C (OR=0.53, 95%CI=0.20-0.93) that was more than TG alone (OR=0.61, 95%CI=0.27-0.98) independently increased the risk of HT in LAA. Furthermore, our established nomogram indicated that lower TG/HDL-C was an indicator of HT. These findings were further validated in the test cohort of 558 patients with AIS attributable to LAA. In summary, a low level of TG/HDL-C is correlated with greater risk of HT after AIS attributable to LAA.

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“…However, the association between those factors and outcomes of AIS remains controversial. In recent years, some studies have suggested that low-density lipoprotein cholesterol (LDL-C) is a new important factor for AIS onset [5,7–9]. The serum LDL-C levels were reported to be positively correlated with AIS status among diabetes, but clinical research for serum LDL-C levels and short-term prognosis outcomes in non-diabetic patients with AIS were relatively small.…”

Section: Introductionmentioning

confidence: 99%

Association Between Low-Density Lipoprotein Cholesterol (LDL-C) Level and Unfavorable Outcomes in Participants of Ischemic Stroke without Diabetes: A Multi-Center Retrospective Study

et al. 2019

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Background The impact of low-density lipoprotein cholesterol (LDL-C) levels on outcomes in patients with non-diabetic acute ischemic stroke remains uncertain. The objective of this study was to explore whether LDL-C could refine outcomes after acute ischemic stroke in patients with non-diabetic acute ischemic stroke. Material/Methods A multi-center, retrospective, clinical-based study was conducted within eight hospitals between January 2015 and August 2016. Adjusted odds ratio (aOR) was used for measurement of unfavorable outcome which was evaluated by the modified Rankin Scale (mRS) score at 6 months after acute ischemic stroke, estimated categorically according to multivariate logistic regression. Results A total of 1614 participants with non-diabetic acute ischemic stroke were enrolled, of which 376 patients (23.3%) had unfavorable neurologic outcomes at 6 months. After multivariate analysis comparing 4 LDL-C levels by quartiles (Q), we found that compared to Q1 (LDL-C level ≤2.41 mmol/L), there was a significant association between the frequency of unfavorable outcomes and levels of LDL-C (Q3: 2.95–3.54 mmol/L) for all participants (adjusted odds ratio [aOR]=0.63; 95% CI: 0.44–0.92, P =0.016) and patients with first ever strokes (aOR=0.52; 95% CI: 0.31–0.87, P =0.013). Conclusions Compared to lower LDL-C levels, non-diabetic patients with LDL-C levels in Q3 (2.95–3.54 mmol/L), were less likely to have unfavorable functional outcomes at 6 months after acute ischemic stroke. Managing HDL-C is one of the most important steps for the recovery of acute ischemic stroke.

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Association of serum lipids with clinical outcome in acute ischaemic stroke: A systematic review and meta-analysis

Cited by 17 publications

References 34 publications

Triglyceride-Glucose Index Linked to Hospital Mortality in Critically Ill Stroke: An Observational Multicentre Study on eICU Database

Triglyceride-Glucose Index Linked to Hospital Mortality in Critically Ill Stroke: An Observational Multicentre Study on eICU Database

Low triglyceride to high-density lipoprotein cholesterol ratio predicts hemorrhagic transformation in large atherosclerotic infarction of acute ischemic stroke

Association Between Low-Density Lipoprotein Cholesterol (LDL-C) Level and Unfavorable Outcomes in Participants of Ischemic Stroke without Diabetes: A Multi-Center Retrospective Study

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