Association study between serum residual cholesterol level at admission and the risk of death after discharge in patients with ischemic stroke
10.3969/j.issn.1004-1648.2025.01.001
- VernacularTitle:缺血性脑卒中患者入院时血清残余胆固醇水平与出院后死亡风险的关联研究
- Author:
Zhanyun REN
1
;
Shiyuan GU
;
Kaidi WU
Author Information
1. 214200 宜兴市人民医院神经内科
- Publication Type:Journal Article
- Keywords:
stroke;
ischemic stroke;
blood lipid level;
remnant cholesterol;
risk of death
- From:
Journal of Clinical Neurology
2025;38(1):1-10
- CountryChina
- Language:Chinese
-
Abstract:
Objective Exploring the relationship between residual cholesterol(RC)levels at admission and the risk of death after discharge in patients with ischemic stroke(IS).Methods Select 2021 IS patients aged 35-80 as the research subjects,and collect endpoint data on mortality after discharge.Using restricted cubic spline(RCS)regression,analyze the dose-response relationship between RC levels at admission and the risk of mortality outcomes in patients.Using Cox regression to calculate hazard ratio(HR)and 95％CI,analyze the association between RC levels at admission and mortality risk after discharge in IS patients.Results According to the RCS model,there is a non-linear correlation between RC levels and deaths from IS and other causes(P＜0.001).Using the median RC level as the cutoff value,the study subjects were divided into low-level RC group(RC＜0.72 mmol/L)and high-level RC group(RC ≥0.72 mmol/L).Compared with those in high level RC group,the age and male ratio in the low level RC group were significantly increased,and the levels of fasting blood glucose(GLU),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C),non high-density lipoprotein cholesterol(HDL-C),apolipoproteins A-1(ApoA-1),apolipoproteins B(ApoB),TG/HDL-C,TG/HDL-C,LDL-C/HDL-C and diabetes ratio were significantly decreased(P＜0.05-0.01).Cox regression analysis showed that,when the covariates were not adjusted,compared with the low level RC group,the high level RC group showed a lower risk of all-cause death(HR=0.765,95％CI:0.619-0.946,P=0.013)and a lower risk of IS death(HR=0.638,95％CI:0.435-0.936,P=0.022);after adjusting for gender,age,smoking history,drinking history,hypertension history and diabetes history,the high level RC group still showed a lower risk of all-cause death(HR=0.760,95％CI:0.614-0.941,P=0.012)and lower IS mortality risk(HR=0.653,95％CI:0.444-0.961,P=0.031).Male(HR=0.753,95％CI:0.572-0.990,P=0.042),age≥65 years old(HR=0.755,95％CI:0.594-0.959,P=0.021),non-smoking(HR=0.746,95％CI:0.590-0.943,P=0.014),non-drinking(HR=0.735,95％CI:0.588-0.919,P=0.007),hypertension(HR=0.738,95％CI:0.580-0.940,P=0.014),without diabetes(HR=0.724,95％CI:0.561-0.934,P=0.013),high levels of RC(≥0.72 mmol/L)were statistically associated with risk of all-cause death reduced.Among patients with age ≥65 years old(HR=0.598,95％CI:0.391-0.916,P=0.018),non-smoking(HR=0.628,95％CI:0.408-0.967,P=0.035),non-drinking(HR=0.656,95％CI:0.439-0.979,P=0.039),without hypertension(HR=0.321,95％CI:0.108-0.957,P=0.041),without diabetes(HR=0.607,95％CI:0.389-0.947,P=0.028),RC ≥0.72 mmol/L was statistically associated with risk of death of IS reduced.After adjusting for age,gender,smoking history,drinking history,hypertension history and diabetes history,among men,age ≥ 65 years old,without diabetes,RC ≥ 0.72 mmol/L was not significantly associated with the increased risk of all-cause death(all P＞0.05);there was no significant correlation between RC ≥ 0.72 mmol/L and the increased risk of death of IS in patients with age ≥ 65 years old,non-smoking,non-drinking,non-hypertension and non-diabetes(all P＞0.05).Compared with the high-level RC group,the low-level RC group had a lower incidence of all-cause death,IS death,and other causes of death,and a higher survival rate.Conclusion The RC level of IS patients which is lower than 0.72 mmol/L at admission will increase the risk of all-cause death and IS death in the long term after discharge.
