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Association between hs-CRP/HDL-C ratio and three-month unfavorable outcomes in patients with acute ischemic stroke: a
Huang Luwen1, Xu Lei1, Ouyang Qing-Rong1
1Department of Neurology, Suining Central Hospital, Suining, Sichuan Province, 629000, China.
Insights
The ratio of high-sensitivity C-reactive protein to HDL cholesterol (hs-CRP/HDL-C) is linked to worse outcomes in acute ischemic stroke (AIS) patients. A higher hs-CRP/HDL-C ratio, especially below 42.74, indicates an increased risk of poor functional outcomes within three months.
Area of Science:
- Cardiovascular Research
- Neurology
- Biomarker Discovery
Background:
- The prognostic value of the high-sensitivity C-reactive protein to high-density lipoprotein cholesterol (hs-CRP/HDL-C) ratio in acute ischemic stroke (AIS) remains unclear.
- This study investigates the association between the hs-CRP/HDL-C ratio and three-month unfavorable outcomes in AIS patients.
Purpose of the Study:
- To establish the relationship between the hs-CRP/HDL-C ratio and clinical outcomes in patients following an acute ischemic stroke.
- To explore potential nonlinear associations and identify critical thresholds for this ratio in predicting stroke outcomes.
Main Methods:
- A secondary analysis of a prospective cohort study including 1559 AIS patients.
- Utilized binary logistic regression and generalized additive models (GAM) to assess the association between the hs-CRP/HDL-C ratio and unfavorable outcomes.
- Employed a recursive method to identify inflection points and develop tailored regression models.
Main Results:
- A statistically significant positive association was found between the hs-CRP/HDL-C ratio and the likelihood of poor outcomes in AIS patients (OR=1.013).
- A nonlinear relationship was observed, with an identified inflection point at a hs-CRP/HDL-C ratio of 42.74.
- Each unit increase in the hs-CRP/HDL-C ratio below this threshold correlated with a 2.4% increased risk of unfavorable outcomes (OR=1.024).
Conclusions:
- The hs-CRP/HDL-C ratio demonstrates a positive, nonlinear correlation with poor three-month functional outcomes in AIS patients.
- A hs-CRP/HDL-C ratio below 42.74 is associated with an elevated risk of adverse outcomes.
- These findings can inform individualized treatment strategies and clinical counseling for AIS patients.
Objective:
The associations between the ratio of blood high-sensitivity C-reactive protein (hs-CRP) to high-density lipoprotein cholesterol (HDL-C) (hs-CRP/HDL-C ratio) and outcomes in patients with acute ischemic stroke (AIS) have yet to be established. This study is the first to examine the relationship between the hs-CRP/HDL-C ratio and three-month unfavorable outcomes in patients with AIS.
Methods:
This secondary analysis utilized data from a prospective cohort study involving 1559 AIS patients recruited at a South Korean hospital between January 2010 and December 2016. We constructed a binary logistic regression model to explore the association between the hs-CRP/HDL-C ratio and unfavorable outcomes in patients with AIS. An attempt was made to use a generalized additive model (GAM) with smooth curve fitting to elucidate potential nonlinear interactions. Furthermore, inflection points were identified via a recursive method, and binary logistic regression models were developed for each side of these inflection points. Ultimately, a log-likelihood ratio test was used to identify the most appropriate model for explaining the connection between the hs-CRP/HDL-C ratio and unfavorable outcomes in patients with AIS.
Results:
The incidence of unfavorable outcomes was 24.5%, with a median hs-CRP/HDL-C ratio of 3.64. After accounting for other factors, the binary logistic regression model revealed a statistically significant positive association between the hs-CRP/HDL-C ratio and the likelihood of poor outcomes in AIS patients (OR = 1.013, 95% CI: 1.005-1.022; P = 0.002). A nonlinear relationship was observed, with the first inflection point of the hs-CRP/HDL-C ratio at 42.74. Each 1-unit increase in the hs-CRP/HDL-C ratio was associated with a 2.4% greater risk of unfavorable outcomes (OR = 1.024, 95% CI: 1.011-1.038, P < 0.001).
Conclusion:
This study provides evidence of a positive and nonlinear correlation between the hs-CRP/HDL-C ratio and poor three-month functional outcomes in AIS patients. When the hs-CRP/HDL-C ratio was less than 42.74, a positive association was observed with the risk of unfavorable outcomes. This finding offers a reference for optimizing early individualized therapy and aids in clinical counseling for patients with AIS.
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