Determinants of Outcome Variability in Ischemic Stroke: A Focus on Routinely Collected Biomarkers

TL;DR

The study explores how biomarkers like CRP and HDL cholesterol relate to stroke outcomes, revealing sex-specific differences and metabolic influences.

Contribution

The study identifies low HDL cholesterol as an independent predictor of disability severity in ischemic stroke patients.

Findings

Men with ischemic stroke were younger, more likely to smoke, and had lower LDL cholesterol compared to women.

Low HDL cholesterol was the sole independent predictor of disability severity in ischemic stroke patients.

Higher CRP levels were associated with moderate disability, but not independently predictive in multivariable analysis.

Abstract

Ischemic stroke remains a leading cause of mortality and disability, with proinflammatory, metabolic, and oxidative stress-related factors contributing to outcome variability. We conducted a retrospective cross-sectional study of 124 consecutive patients (53 women, 71 men; median age 71 [62–76]) discharged with ICD-10 code I69.3 from the Neurology Department of the Clinical Rehabilitation Hospital in Cluj-Napoca (January 2023–September 2024). Men were younger (median age of 69 vs. 73 years, p-value = 0.010), more frequently smokers (42% vs. 9%, p < 0.001), and alcohol consumers (21% vs. 4%, p-value = 0.007) than women. In contrast, women were more frequently sedentary (68% vs. 49%, p-value = 0.038) and had higher LDL cholesterol (89 vs. 74 mg/dL, p = 0.026) than men. Patients with at least moderate disability (n = 84) presented higher levels of C-Reactive Protein (CRP), 1.4 vs. 1.1 mg/L, p-value = 0.027) and more frequently low HDL cholesterol serum levels (29.8% vs. 7.5%, p-value = 0.006) compared to those with minor disability. In multivariable regression, low HDL was the sole independent predictor of disability severity (OR = 4.58, 95% CI 1.21–17.41; AUC = 0.78, sensitivity = 88%, specificity = 42%), while CRP and age did not retain the significance obtained in univariable regression. Our findings highlight sex-specific risk profiles and underline the contribution of proinflammatory, metabolic, and oxidative pathways to ischemic stroke severity, underscoring the need for prospective validation in larger cohorts.

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