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 (P_interaction = 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.

中文翻译：

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血脂水平与慢性肾脏病患者急性缺血性卒中严重程度和结局的相关性

背景

血脂对中风严重程度和结果的影响尚无定论，慢性肾病 (CKD)（估计肾小球滤过率 < 60 mL/min/1.73 m ²）是否影响这种关联尚未得到研究。我们的目标是评估这种关系。

方法

对连续的急性缺血性卒中患者进行了回顾性研究。我们评估了入院时美国国立卫生研究院卒中量表 (NIHSS) ≥ 5 的严重卒中风险和出院时改良 Rankin 量表 (mRS) ≥ 3 的不良结局。根据 CKD 分层的脂质水平四分位数，采用多变量逐步逻辑回归模型来研究脂质成分与卒中严重程度和结果的相互作用和独立关联。

结果

在 875 名患者中（平均年龄 64.9 岁，男性占 67.8%），213 名（24.3%）患有 CKD。与非 CKD 患者相比，低密度脂蛋白胆固醇 (LDL-C) 升高与 CKD 患者的严重卒中独立相关（趋势P = 0.033）（趋势P = 0.121）。低密度脂蛋白胆固醇水平与中风严重程度之间的关联被 CKD 明显改变（P_交互作用 = 0.013）。与 LDL-C 最低四分位数未患 CKD 的患者相比，LDL-C 最高四分位数的 CKD 患者经多变量调整后发生严重卒中的风险显着增加了 2.9 倍（95% CI 1.48–5.74）。在有和没有 CKD 的患者中，没有观察到脂质成分与早期结果之间的显着关联。

结论

只有 CKD 患者的 LDL-C 水平与卒中严重程度呈正相关，LDL-C 和 CKD 对急性期缺血性卒中具有交互影响。