Association of Non-Traditional Lipid Parameters with Hemorrhagic Transformation and Clinical Outcome After Thrombolysis in Ischemic Stroke Patients

OBJECTIVE: Recently, a few studies have shown that non-traditional lipid parameters are associated with the hemorrhagic transformation (HT) and the clinical outcome of ischemic stroke. However, the role of non-traditional lipid parameters in ischemic stroke patients treated with intravenous thrombolysis remains unclear. Thus, we aimed to assess the associations of non-traditional lipid parameters with HT and clinical outcome after thrombolysis in ischemic stroke patients. METHODS: This study consecutively included 763 ischemic stroke patients treated with intravenous thrombolysis. Non-traditional lipid parameters included non-high-density lipoprotein cholesterol (non-HDL-C), total cholesterol to HDL-C ratio (TC/HDL-C), triglyceride to HDL-C ratio (TG/ HDL-C), and low-density lipoprotein cholesterol to HDL-C ratio (LDL-C/HDL-C). Receiver operating characteristic (ROC) curves and multivariate logistic regression analyses were used to investigate the associations between the four non-traditional lipid parameters and HT and poor outcome after thrombolysis. RESULTS: Of 763 patients, 78 (10.2%) had HT and 281 (36.8%) had poor outcome. The ROC curves showed that the optimum cut-off points of the non-HDL-C, TC/HDL-C, TG/HDL-C, and LDL/HDL-C for predicting HT and poor outcome were 2.99 and 2.01, 4.05 and 3.66, 0.82 and 1.02, as well as 2.67 and 2.71, respectively. Multivariate logistic regression analyses showed that the TC/HDL-C <4.05 (adjusted odds ratio [OR]=1.727, 95% confidence interval [CI]: 1.008-2.960), TG/HDL-C <0.82 (adjusted OR=2.064, 95% CI: 1.241-3.432), and LDL/HDL-C <2.67 (adjusted OR=1.935, 95% CI: 1.070-3.501) were positively associated with the risk of HT, while the non-HDL-C <2.99 (adjusted OR=0.990, 95% CI: 0.583-1.680) was not related to the risk of HT. In addition, the non-HDL-C <2.01, TC/HDL-C <3.66, TG/HDL-C <1.02, and LDL/HDL-C <2.71 were associated with an increased risk of poor outcome, with adjusted ORs of 2.340 (95% CI: 1.150-4.764), 1.423 (95% CI: 1.025-1.977), 1.539 (95% CI: 1.102-2.151), and 1.608 (95% CI: 1.133-2.283). CONCLUSION: Low TC/HDL-C, TG/HDL-C, and LDL/HDL-C, but not non-HDL-C, were associated with an increased risk of HT after thrombolysis. In addition, low non-HDL-C, TC/HDL-C, TG/HDL-C, and LDL/HDL-C were associated with an increased risk of poor outcome in ischemic stroke patients with intravenous thrombolysis.