# Elevated WBC/HDL Ratio Predicts Poststroke Functional Prognosis

## TL;DR

This study shows that a high white blood cell to HDL cholesterol ratio at admission predicts worse recovery outcomes in stroke patients.

## Contribution

The WBC/HDL ratio is introduced as a novel and practical biomarker for early risk stratification in acute ischemic stroke.

## Key findings

- Higher WBC/HDL ratios are significantly associated with poor 90-day functional outcomes in stroke patients.
- The highest WBC/HDL tertile had nearly twice the risk of poor outcomes compared to the lowest tertile.
- The relationship remained consistent across subgroups like sex, stroke severity, and comorbidities.

## Abstract

Inflammation and lipid metabolism play critical roles in the pathogenesis and outcome of acute ischemic stroke (AIS). The white blood cell to high‐density lipoprotein cholesterol ratio (WBC/HDL) has been identified as a novel composite biomarker reflecting systemic inflammatory status and anti‐inflammatory capacity. We sought to evaluate the prognostic value of WBC/HDL in predicting 90‐day functional outcomes among AIS patients.

We retrospectively enrolled 837 AIS patients. Baseline WBC/HDL ratios were calculated at admission. The primary endpoint was 90‐day functional outcome, assessed by the modified Rankin Scale, with scores > 2 defined as unfavorable outcomes. Associations between WBC/HDL and outcomes were assessed through logistic regression, restricted cubic spline (RCS) curves, and subgroup analysis.

Higher WBC/HDL ratios were significantly associated with poor functional outcomes. The association remained robust after adjustment for key covariates (adjusted OR: 1.2589; p = 0.0001). The highest WBC/HDL tertile had nearly twice the risk of poor outcomes compared with the lowest tertile. The RCS analysis demonstrated a linear dose–response relationship. Subgroup analyses revealed a consistent relationship across sex, stroke severity, and comorbidity groups, without significant interactions.

The WBC/HDL ratio independently predicts 90‐day functional outcomes in AIS and represents a practical biomarker for early risk stratification.

Elevated admission white blood cell to high‐density lipoprotein cholesterol ratio (WBC/HDL) independently predicts poor 90‐day functional outcomes in acute ischemic stroke patients, supporting its use as a simple biomarker for early risk stratification.