INTRODUCTION Aneurysmal subarachnoid hemorrhage (aSAH) is devastating, with delayed cerebral ischemia (DCI) significantly contributing to the high morbidity and mortality rates. Cholesterol has been studied as a measure of nutritional status in other neurological pathologies, but reports examining cholesterol's effects on aSAH outcomes are sparse. This study aimed to elucidate the effect of low total cholesterol (TC) and high density lipoprotein (HDL) on mortality and DCI following aSAH. METHODS We performed a retrospective cohort study at a quaternary academic medical center between June 2014 and July 2018. All patients had aSAH confirmed by digital subtraction angiography and had TC measured on admission. Primary outcomes were mortality and DCI. Secondary outcome was radiographic vasospasm. Univariate and multivariate logistic regressions were performed. RESULTS There were 75 aSAH patients, with an average age of 58.7 ± 1.7 (range: 14-89) and Hunt & Hess score of 2.8 ± 0.1, included for analysis. Those with a low TC < 160 mg/dL had 3 times increased odds of DCI (OR = 3.4; 95 %CI: 1.3-9.0; p = 0.0175) and a nearly 5 times increased odds of death (OR = 4.9; 95 %CI: 1.1-18.3; p = 0.0339). Low HDL < 40 mg/dL was associated with 12 times increased odds of DCI (OR = 12.3; 95 %CI: 2.7-56.4; p = 0.0003) but no significant differences in death (p = 0.2205). In multivariate analysis, low TC was an independent risk factor for increased mortality (OR = 5.6; 95 %CI: 1.2-27.6; p = 0.0335) while low HDL was associated with increased risk for DCI (OR = 17.9; 95 %CI: 3.1-104.4; p = 0.0013). There was no effect of TC or HDL on radiographic vasospasm. CONCLUSIONS Low TC and HDL are independent predictors of increased mortality and DCI, respectively, following aSAH. Low TC and HDL may be markers of poor overall health, in addition to having some pathophysiological effect on cerebral vasculature. These results may have practical implications for the improvement of aSAH prognostication and management.

中文翻译：

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低总胆固醇和高密度脂蛋白是动脉瘤性蛛网膜下腔出血后不良预后的独立预测因素：初步报告

引言 动脉瘤性蛛网膜下腔出血 (aSAH) 是毁灭性的，延迟性脑缺血 (DCI) 显着导致高发病率和死亡率。胆固醇已被研究作为衡量其他神经病理学中营养状况的指标，但关于检查胆固醇对 aSAH 结果影响的报告很少。本研究旨在阐明低总胆固醇 (TC) 和高密度脂蛋白 (HDL) 对 aSAH 后死亡率和 DCI 的影响。方法 我们于 2014 年 6 月至 2018 年 7 月期间在四级学术医疗中心进行了一项回顾性队列研究。所有患者均通过数字减影血管造影术确认 aSAH，并在入院时测量了 TC。主要结果是死亡率和 DCI。次要结果是影像学血管痉挛。进行了单变量和多变量逻辑回归。结果 共有 75 名 aSAH 患者，平均年龄为 58.7 ± 1.7（范围：14-89），Hunt & Hess 评分为 2.8 ± 0.1，纳入分析。低 TC < 160 mg/dL 的患者发生 DCI 的几率增加了 3 倍（OR = 3.4；95 %CI：1.3-9.0；p = 0.0175），死亡几率增加了近 5 倍（OR = 4.9；95 %） CI：1.1-18.3；p = 0.0339）。低 HDL < 40 mg/dL 与 DCI 几率增加 12 倍相关（OR = 12.3；95 %CI：2.7-56.4；p = 0.0003），但在死亡方面没有显着差异（p = 0.2205）。在多变量分析中，低 TC 是死亡率增加的独立危险因素（OR = 5.6；95 %CI：1.2-27.6；p = 0.0335），而低 HDL 与 DCI 风险增加相关（OR = 17.9；95 %CI： 3.1-104.4；p = 0.0013)。TC 或 HDL 对影像学血管痉挛没有影响。结论 低 TC 和 HDL 分别是 aSAH 后死亡率和 DCI 增加的独立预测因子。除了对脑血管系统有一些病理生理影响外，低 TC 和 HDL 可能是整体健康状况不佳的标志。这些结果可能对改善 aSAH 的预后和管理具有实际意义。