title: The total cholesterol to high-density lipoprotein cholesterol as a predictor of poor outcomes in a Chinese population with acute ischaemic stroke.
abstract: BACKGROUND
  High admission cholesterol has been associated with better outcome after acute ischaemic stroke (AIS), but a paradox not completely illustrated. The purpose of this study was to investigate the effect of the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) on short-term survival after AIS.
  
  
  METHODS
  Consecutive patients admitted in 2013 and 2015 were enrolled in the present study. The logistic regression analysis was conducted to evaluate predictors of 3-month outcomes. The primary endpoint was death. Secondary endpoint was good (modified Rankin Scale score 0-2 or equal to prestrike modified Rankin Scale score) at 3 months.
  
  
  RESULTS
  Of 871 patients enrolled in the final analysis, 94 (10.8%) individuals died during 3 months of observation. The serum TC and TC/HDL-C levels at admission were significantly associated with stroke outcomes at 3 months, and the HDL-C level was only correlated with the good outcomes at 3 months. Mortality risk was markedly decreased for patients with high TC/HDL-C ratio (odds ratio: 0.23, 95% confidence interval [CI]: 0.10-0.50 for Q4:Q1; P-trend <.001) after adjustment. The effect of TC/HDL-C ratio on the probability of good outcomes was still obvious (odds ratio: 2.18, 95% CI: 1.40-3.39 for Q4:Q1; P-trend=.029). According to the receiver operating characteristic analyses, the best discriminating factor was a TG/HDL-C ≥3.37 (area under the ROC curve [AUC]=0.643, sensitivity 61.3%, specificity 61.7%) as well as the TC/HDL-C ≥4.09 for good outcomes (AUC: 0.587, sensitivity 63.9%, specificity 79.7%).
  
  
  CONCLUSIONS
  High TC/HDL-C ratio may be associated with increased short-term survival and better outcomes after AIS.
authors.affiliation: Department of Emergency, The first affiliated hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Lifang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Emergency, The first affiliated hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Jianing
authors.initials: J
authors.lastname: Xu
authors.affiliation: Department of Emergency, The first affiliated hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Sun
authors.affiliation: Department of Emergency, The first affiliated hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Wu
authors.affiliation: Department of Emergency, The first affiliated hospital with Nanjing Medical University, Nanjing, Jiangsu, China.
authors.forename: Jinsong
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood*; D008076:Cholesterol, HDL / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D008076:Cholesterol, HDL; D002784:Cholesterol
keywords: HDL-C; TC; cholesterol; stroke; survival