Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry

Abstract

The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160–200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41–2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11–1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76–8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.

Pre‐stroke physical activity is associated with fewer post‐stroke complications, lower mortality and a better long‐term outcome

“…All registered patients with stroke were followed up in clinics at 1, 3 and 6 months post‐stroke. For those who could not visit the clinic, the functional outcome, stroke recurrence and survival status were determined by telephone interviews .…”

The predictive role of the neutrophil–lymphocyte ratio in the prognosis of adult patients with stroke

“…It has been reported that ischemic stroke accounts for approximately 85% of strokes [2], and it is characterized by a disruption in cerebral blood flow [3], while hemorrhagic stroke is characterized by bleeding within the intracranial space [4]. In addition to the characteristics of the haematoma, such as volume and location [5,6], other factors, such as blood pressure variability [7] and cholesterol and ferritin levels [8,9], and brain imaging parameters [10] have been reported to be related to the prognosis of hemorrhagic stroke patients. In ischemic stroke, infarct volume and location influence the severity of prognosis.…”

Prognostic role of neutrophil lymphocyte ratio in patients with spontaneous intracerebral hemorrhage

“…However the optimal treatment of high blood pressure after ICH is still controversial [ 9 ]. Some biochemical parameters, such as cholesterol and ferritin level, were also reported to be biomarkers of outcomes [ 10 , 11 ]. Besides, it has been suggested that brain imaging parameters may predict outcome in ICH patients, for example, satellite sign and blend sign in the initial CT scan [ 12 , 13 ].…”