Association of lipid profiles with severity and outcome of acute ischemic stroke in patients with and without chronic kidney disease

摘要

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 m~2) 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.