Value Of Low-density Lipoprotein To Lymphocyte Ratio In Predicting In-hospital Death In Acute Ischemic Stroke

PurposeThis study is to investigate the value of low-density lipoprotein cholesterol(LDL-C)to lymphocyte(LYM)ratio(LDL-C/LYM value)in predicting in-hospital mortality in patients with acute ischemic stroke(AIS).The results of this study may provide a basis for reducing mortality in acute ischemic stroke,and may also provide clinicians with important information to determine prognosis and guide treatment.MethodsPatients with acute cerebral infarction who attended the First Affiliated Hospital of Dali University between January 2016 and December 2020 were collected.All patients completed laboratory laboratory tests of blood biochemistry and routine blood tests and imaging within 24 hours of admission,and were divided into an experimental group(Died of acute ischemic stroke AIS-D)based on whether the patients experienced in-hospital death,and patients with acute ischemic stroke who did not experience in-hospital death during the same period were selected as the control group(Survived from The National Institute of Health stroke scale NIHSS)and TOAST typing(Trial of Org 10 172)were performed on patients in both groups.The basic information of the experimental group and the control group was recorded in detail: age,gender,smoking history,etc.;previous diseases such as hypertension,diabetes,atrial fibrillation,cerebral infarction and other risk factors for cerebrovascular disease;post-admission complications such as brain herniation,stroke-associated pneumonia SAP,infarction,etc.were collected.The patients’ complications such as brain herniation,Stroke-associated pneumonia SAP,hemorrhagic transformation of ischemic stroke HT,respiratory and cardiac arrest,gastrointestinal bleeding,etc.were collected after admission.The patients’ blood biological indicators such as white blood cells,absolute lymphocyte count,C-reactive protein,homocysteine,LDL-C,etc.were collected and statistically analyzed using SPSS 24.0 software.Results1.177 patients were included in this study,72 in the AIS-D group and 105 in the AIS-S group.The differences were statistically significant(P < 0.05)when comparing the two groups in terms of history of atrial fibrillation,baseline NHISS score,post-admission complications(brain herniation,SAP,HT),and TOAST staging(cardiogenic cerebral embolism,small artery occlusive cerebral infarction).2.Comparison of blood biological indexes between the two groups,in which the serum leukocyte level and LDL-C/LYM values in the experimental group were significantly higher than those in the control group,and the differences were statistically significant(P < 0.05).3.Logistic multi-factor regression analysis,after adjusting for confounding factors,showed that LDL-C/LYM values and NIHSS scores were independent risk factors for the occurrence of in-hospital death in acute stroke patients(P<0.05).4.Subject working characteristic(ROC)curve analysis The area under the NHISS score curve AUC was 0.862(95% CI: 0.809,0.915)and the area under the LDL-C/LYM value curve AUC was 0.901(95% CI: 0.851,0.951).Further analysis showed that the best cut-off point of NHISS score was 13 when the The highest prediction accuracy was achieved with a Yordon index of up to 0.571,sensitivity of 0.847 and specificity of0.724;when the optimal cut-off point of LDL-C/LYM value was 1.8050,the highest prediction accuracy was achieved with a Yordon index of up to 0.714,sensitivity of0.847 and specificity of 0.867.5.LDL-C/LYM values in patients with in-hospital death occurring after AIS were positively correlated with patient age,WBC,NIHSS score,pulmonary infection,brain herniation,post-infarction hemorrhagic transformation,and cardiogenic cerebral embolism(P<0.05)and negatively correlated with small artery occlusive cerebral infarction(P<0.05).Conclusion1.LDL-C/LYM values and NIHSS scores are independent risk factors for in-hospital mortality in AIS patients,and high LDL-C/LYM values in early stages have high value in predicting in-hospital mortality in AIS patients.2.LDL-C/LYM values of AIS patients increase with NIHSS score,so LDL-C/LYM values can reflect the severity of patients’ disease to some extent.3.Serum LDL-C/LYM values in AIS patients correlate with age,baseline NIHSS score,admission leukocytes,different TOAST typing,and admission complications(SAP,HT,brain herniation),and it is recommended to consider these factors when evaluating the condition.