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Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry.

Abstract The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with <160, 160-200 and >200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41-2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11-1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76-8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title plos one
Publication Year Start




PMID- 28422955
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - Low cholesterol level associated with severity and outcome of spontaneous
      intracerebral hemorrhage: Results from Taiwan Stroke Registry.
PG  - e0171379
LID - 10.1371/journal.pone.0171379 [doi]
AB  - The relationship between cholesterol level and hemorrhagic stroke is
      inconclusive. We hypothesized that low cholesterol levels may have association
      with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes.
      This study used data obtained from a multi-center stroke registry program in
      Taiwan. We categorized acute spontaneous ICH patients, based on their baseline
      levels of total cholesterol (TC) measured at admission, into 3 groups with &lt;160, 
      160-200 and &gt;200 mg/dL of TC. We evaluated risk of having initial stroke
      severity, with National Institutes of Health Stroke Scale (NIHSS) &gt;15 and
      unfavorable outcomes (modified Rankin Scale [mRS] score &gt;2, 3-month mortality)
      after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5+/-14.2
      years; 64.2% men) were included in this study and 854 (34.9%) of them had
      baseline TC &lt;160 mg/dL. Patients with TC &lt;160 mg/dL presented more often severe
      neurological deficit (NIHSS &gt;15), with an adjusted odds ratio [aOR] of 1.80; 95% 
      confidence interval [CI], 1.41-2.30), and 3-month mRS &gt;2 (aOR, 1.41; 95% CI,
      1.11-1.78) using patients with TC &gt;200 mg/dL as reference. Those with TC &gt;160
      mg/dL and body mass index (BMI) &lt;22 kg/m2 had higher risk of 3-month mortality
      (aOR 3.94, 95% CI 1.76-8.80). Prior use of lipid-lowering drugs (2.8% of the ICH 
      population) was not associated with initial severity and 3-month outcomes. A
      total cholesterol level lower than 160 mg/dL was common in patients with acute
      ICH and was associated with greater neurological severity on presentation and
      poor 3-month outcomes, especially with lower BMI.
FAU - Chen, Yu-Wei
AU  - Chen YW
AD  - Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan.
AD  - Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Li, Chen-Hua
AU  - Li CH
AD  - Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan.
AD  - Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Yang, Chih-Dong
AU  - Yang CD
AD  - Department of Neurosurgery, Taiwan Landseed Hospital, Taoyuan, Taiwan.
FAU - Liu, Chung-Hsiang
AU  - Liu CH
AD  - Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
FAU - Chen, Chih-Hung
AU  - Chen CH
AD  - Department of Neurology, National Cheng Kung University Hospital, College of
      Medicine, National Cheng Kung University, Tainan, Taiwan.
FAU - Sheu, Jau-Jiuan
AU  - Sheu JJ
AD  - Department of Neurology, Taipei Medical University Hospital, Taipei, Taiwan.
FAU - Lin, Shinn-Kuang
AU  - Lin SK
AD  - Department of Neurology, Taipei Tzu Chi Hospital, and School of Medicine, Tzu Chi
      University, Hualien, Taiwan.
FAU - Chen, An-Chih
AU  - Chen AC
AD  - Department of Neurology, Chung Shan Medical University Hospital, Taichung,
      Taiwan.
FAU - Chen, Ping-Kun
AU  - Chen PK
AD  - Department of Neurology, Lin Shin Hospital, Taichung, Taiwan.
FAU - Chen, Po-Lin
AU  - Chen PL
AD  - Department of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan.
FAU - Yeh, Chung-Hsin
AU  - Yeh CH
AD  - Department of Neurology, Yuan Rung Hospital, Changhua, Taiwan.
AD  - Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan.
AD  - Department of Nursing, College of Medicine &amp; Nursing, Hung-Kuang University,
      Taichung, Taiwan.
FAU - Chen, Jiunn-Rong
AU  - Chen JR
AD  - Department of Neurology, Yunlin Christian Hospital, Yunlin, Taiwan.
FAU - Hsiao, Yu-Jen
AU  - Hsiao YJ
AD  - Department of Neurology, National Taiwan University Hospital-Yunlin Branch,
      Yunlin, Taiwan.
FAU - Lin, Ching-Huang
AU  - Lin CH
AD  - Department of Neurology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
FAU - Hsu, Shih-Pin
AU  - Hsu SP
AD  - Department of Neurology, E-Da Hospital, Kaohsiung, Taiwan.
FAU - Chen, Tsang-Shan
AU  - Chen TS
AD  - Department of Neurology, Sin-Lau Hospital, Tainan, Taiwan.
FAU - Sung, Sheng-Feng
AU  - Sung SF
AD  - Division of Neurology, Department of Internal Medicine, Ditmanson Medical
      Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
FAU - Yu, Shih-Chieh
AU  - Yu SC
AD  - Department of Neurology, Kuang Tien General Hospital, Taichung, Taiwan.
FAU - Muo, Chih-Hsin
AU  - Muo CH
AD  - Management Office for Health Data, China Medical University Hospital, Taichung,
      Taiwan.
FAU - Wen, Chi Pang
AU  - Wen CP
AD  - National Health Research Institutes, Miaoli, Taiwan.
AD  - Department of Health Services Administration, China Medical University, Taichung,
      Taiwan.
FAU - Sung, Fung-Chang
AU  - Sung FC
AD  - Department of Health Services Administration, China Medical University, Taichung,
      Taiwan.
FAU - Jeng, Jiann-Shing
AU  - Jeng JS
AD  - Department of Neurology, Taiwan Landseed Hospital, Taoyuan, Taiwan.
AD  - Stroke Center, National Taiwan University Hospital, Taipei, Taiwan.
FAU - Hsu, Chung Y
AU  - Hsu CY
AD  - Graduate Institute of Clinical Medical Science, China Medical University,
      Taichung, Taiwan.
CN  - Taiwan Stroke Registry Investigators
LA  - eng
PT  - Journal Article
DEP - 20170419
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
PHST- 2016/08/29 [received]
PHST- 2017/01/18 [accepted]
AID - 10.1371/journal.pone.0171379 [doi]
AID - PONE-D-16-34627 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 19;12(4):e0171379. doi: 10.1371/journal.pone.0171379.
      eCollection 2017.

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