# 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.

## Key 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.