Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic ki
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ORIGINAL ARTICLE
Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease Ailing Zhang 1 Ling Cui 1
&
Wenjing Deng 2 & Bin Zhang 1 & Mengyang Ren 1 & Long Tian 1 & Jihui Ge 1 & Jinjuan Bai 1 & Hao Hu 1 &
Received: 14 June 2020 / Accepted: 3 October 2020 # The Author(s) 2020
Abstract 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 lowdensity 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 (Pinteraction = 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. Keywords Ischemic stroke . Chronic kidney disease . Lipoproteins . Severity
Introduction Stroke and renal dysfunction have rapid growth trends in many countries with increasing prevalence rates of hypertension, diabetes mellitus, hyperlipidemia, and obesity [1]. The prevalence of chronic kidney disease (CKD) is estimated to be about 8–16% in the general population, and it is most common among cardiovascular disease and stroke populations [2].
* Ailing Zhang [email protected] 1
Department of Neurology, People’s Hospital of Zhengzhou, Zhengzhou City 450003, Henan Province, China
2
The Neurology Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City 450000, Henan Province, China
Furthermore, the impact of CKD on stroke seems to be greater in Asian patients than non-Asian patients [2]. Patients with CKD often have dyslipidemia [3, 4], which is an important pathogenic factor of atherosclerosis and a modifiable risk factor for cardio- and cere
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