Cumulative Exposure to Oxidized Low-Density Lipoprotein is a Potential Predictor for Prognosis in Acute Ischemic Stroke: A Cohort Study

Abstract

Abstract Background Oxidized low-density lipoprotein (ox-LDL) is closely related to the recrudescence and prognosis of acute ischemic stroke (AIS). However, there are limited studies about the effect of a long-term elevation of ox-LDL in AIS. In this research, our porpose was to explore the relevence between cumulative ox-LDL exposure and the short-term prognosis of AIS. Methods This study recruited patients with AIS. AIS severity was evaluated by infarct volumes and National Institute of Health Stroke Scale (NIHSS) scores at admission. AIS prognosis was assessed by Modified Rankin Scale (mRS) scores at 90 days and the difference between NIHSS scores at admission and discharge. Cumulative ox-LDL exposure was defined as ox-LDL level (pg/mL) multiplied by age (y). A multivariate logistic regression model was employed to investigate the correlation between exposure factors and the prognosis of AIS. The predictive ability of cumulative ox-LDL exposure for the prognosis of AIS was compared with cumulative LDL exposure by the receiver operating characteristic curve (ROC). Results A total of 175 AIS patients were included with an average age of 66.00 (61.00, 73.00). Patients with higher cumulative ox-LDL exposure tended to manifest worse prognosis, including neurological worsening at discharge (NIHSS increasing more than 2 points) (OR = 3.02, 95% CI, 1.30–6.98, P = 0.01) and poor functional prognosis at 90 days (mRS ≥ 3) (OR = 21.21, 95% CI, 4.72–95.36, P < 0.001). After adjusting for potential confounders, multivariate regression analysis showed significantly increased cumulative ox-LDL exposure was elated to poor functional prognosis at 90 days (OR = 9.92, 95% CI, 1.23–79.76, P = 0.031), but not with neurological worsening at discharge (OR = 1.74, 95% CI, 0.46–6.55, P = 0.414). ROC curve revealed that ox-LDL cumulative exposure had higher predictive value (AUC = 0.843, P < 0.001) for the functional prognosis of AIS than cumulative LDL exposure (AUC = 0.629, P = 0.023). Conclusion High cumulative ox-LDL exposure is related to the poor prognosis at 3-month of AIS, and its predictive accuracy is better than cumulative LDL exposure.