title: High-density lipoprotein: a novel marker for risk of in-hospital infection in acute ischemic stroke patients?
abstract: BACKGROUND
  Several studies have shown that high-density lipoprotein (HDL) cholesterol provides protection against bacterial infections. Our aim was to investigate the influence of HDL cholesterol levels on the risk of developing in-hospital infectious complications after an acute ischemic stroke (IS) as well as the possible effect of prestroke statin treatment on this association.
  
  
  RESULTS
  Observational study that included consecutive IS patients during a 5-year period (2006-2010). We analyzed vascular risk factors, prestroke treatments (including statins), laboratory data (including HDL cholesterol levels), stroke severity, and the development of infectious complications (pneumonia, urinary tract infection and sepsis). A multivariate analysis that included HDL cholesterol levels, prior statin treatment and the interaction between both variables was performed to identify those factors associated with the presence of infectious complications. A total of 1,385 patients were included, 130 of whom (9.4%) developed in-hospital infections. The receiver operating characteristic curve showed the predictive value of HDL cholesterol with an area under the curve of 0.597 (95% CI, 0.526-0.668; p = 0.006) and pointed to 38.5 mg/dl of HDL cholesterol (65.5% sensitivity and 53.4% specificity) as the optimal cutoff level for developing infectious complications during hospitalization. An HDL cholesterol level ≥38.5 mg/dl was an independent predictive factor for lower risk of infection (OR 0.308; 95% CI 0.119-0.795), whereas prestroke statin treatment was not associated with the development of infection.
  
  
  CONCLUSIONS
  An HDL cholesterol level ≥38.5 mg/dl was independently associated with lower risk for developing infectious complications in acute IS patients. Statins do not influence this association.
authors.affiliation: Department of Neurology and Stroke Center, Neuroscience Research Area, IdiPAZ Health Research Institute, La Paz University Hospital, Autonoma University of Madrid, IDIPAZ, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Sanz
authors.forename: Blanca
authors.initials: B
authors.lastname: Fuentes
authors.forename: Patricia
authors.initials: P
authors.lastname: Martínez-Sánchez
authors.forename: Daniel
authors.initials: D
authors.lastname: Prefasi
authors.forename: Marta
authors.initials: M
authors.lastname: Martínez-Martínez
authors.forename: Elisa
authors.initials: E
authors.lastname: Correas
authors.forename: Exuperio
authors.initials: E
authors.lastname: Díez-Tejedor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002545:Brain Ischemia / Q000097:blood / Q000150:complications*; D008078:Cholesterol, LDL / Q000097:blood; D003428:Cross Infection / Q000097:blood* / Q000150:complications; D005260:Female; D006760:Hospitalization; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D020521:Stroke / Q000097:blood / Q000150:complications*
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D008075:Lipoproteins, HDL