| Objective Low serum low-density lipoprotein cholesterol(LDL-C)levels are now known to increase the risk of death in patients with cerebral hemorrhage.Cerebral hematoma expansion(HG)has become recognized as an important risk factor leading to poor prognosis of cerebral hemorrhage.Whether LDL-C levels are associated with HG and whether they predict HG has become a hot topic that is currently controversial.LDL-C levels have been shown to predict HG,but most studies have focused on selecting patients with supratentorial(including thalamus,lobes,and basal ganglia)intracerebral hemorrhage who have a higher incidence,and whether there is the above correlation for patients with infratentorial(structures other than supratentorial structures,including cerebellum,brainstem,etc.)intracerebral hemorrhage and ventricular hemorrhage who are at greater risk and risk of death.Therefore,we investigated the relationship between LDL-C levels and the prognosis of patients with HG and cerebral hemorrhage in patients with acute cerebral hemorrhage.Methods We prospectively studied 338 consecutive patients with spontaneous acute intracerebral hemorrhage who underwent the first computed tomography(CT)examination of the brain and measured the amount of cerebral hematoma in the emergency department within 6 hours of onset and were admitted within 12 hours for diagnosis and treatment.The National Institutes of Health Stroke Scale(NIHSS score)was recorded at baseline and 24 hours,and lipid profile analysis,reexamination of brain CT,and accurate measurement were performed within 24 hours of onset to calculate the amount of brain hematoma.The measurement of hematoma volume twice was performed using 3D Slicer software.The professional neurologist copied the patient ’s brain CT image into the software at DICOM,adjusted the threshold to highlight the hematoma,outlined the hematoma contour with the paintbrush function and smeared layer by layer,which would simultaneously display the area of the coated area and could present a 3D model of the hematoma.Intraventricular hematoma was measured in the same manner.HG was defined as a 33% or 6 ml increase in hematoma at 24 h.However,the definition of HG was more complex for ventricular hemorrhage,and we adopted the latest criteria for the definition of ventricular hematoma enlargement.NIHSS scores at baseline and 24 hours after onset were compared to assess the degree of early neurological deterioration(an increase in NHISS score of ≥ 4 points or patient non-survival indicating the presence of early neurological deterioration END).Patients were followed up three months after onset,and the prognosis was assessed with the modified Rankin Scale(mRS score)(mRS score > 2 indicates poor prognosis).Results Although there was no significant correlation between LDL-C levels and hematoma volume in intracerebral hemorrhage(r =-0.087,P = 0.110),there was also no correlation with NHISS score(r =-0.066,P = 0.226).However,low LDL-C levels were associated with hematoma expansion(1.75 [1.06;2.19] mmol/L and 2.23[1.71;3.17] mmol/L,p<0.001),early neurological deterioration(1.65 [1.17;2.10]mmol/L and 2.20 [1.66;2.96] mmol/L,p<0.001),but not 3-month prognosis 2.08[1.53;2.80] mmol/L and 2.05 [1.57;2.83]mmol/L,P=0.856).In addition,LDL-C levels were negatively associated with 24 h hematoma expansion in multivariate logistic regression analysis(OR = 0.310;95% CI,0.208-0.463;P < 0.001).According to ROC curve analysis,LDL-C level < 2.68 mmol/L was an independent predictor of HG(AUC = 0.728,P < 0.001),and LDL-C level < 2.185 mmol/L had a better predictive effect on END(AUC = 0.707,P < 0.001).According to different bleeding sites,low LDL-C levels were associated with HG(1.69 ± 0.68 mmol/L and 2.63 ± 1.26 mmol/L,t = 6.131,p < 0.001)and END(1.74 ± 0.78 mmol/L and 2.55 ± 1.24 mmol/L,t =4.629,p < 0.001),but not with 3-month prognosis(2.36 ± 1.16 mmol/L and 2.42 ±1.25 mmol/L,t = 0.41,p = 0.682)in patients with supratentorial bleeding;low LDL-C levels were associated with END(1.65 ± 0.53 mmol/L and 2.63 ± 1.32 mmol/L,t =2.147,p = 0.039),but with HG(1.64 ± 0.68 mmol/L and 2.60 ± 1.30 mmol/L,t =2.011,p = 0.052)and 3-month prognosis(2.43 ± 1.46 mmol/L and 2.38 ± 1.13mmol/L,p = 0.122)in patients with supratentorial bleeding In patients with ventricular hemorrhage,LDL-C was associated with HG(1.72 ± 0.81 mmol/L and2.34 ± 1.27 mmol/L,t = 0.961,p = 0.359),END(1.89 ± 1.34 mmol/L and 2.12 ± 1.13mmol/L,t = 0.275,Fig.P = 0.789)and 3-month prognosis(2.09 ± 1.43 mmol/L and2.07 ± 0.52 mmol/L,t =-0.035,p = 0.972)were not associated.Conclusion Low level of serum LDL cholesterol can independently predict hematoma expansion and early neurological deterioration,but has no correlation with the prognosis of patients with cerebral hemorrhage.It may become a promising target for intervention. |
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