PLoS ONE (Jan 2017)

Low cholesterol level associated with severity and outcome of spontaneous intracerebral hemorrhage: Results from Taiwan Stroke Registry.

  • Yu-Wei Chen,
  • Chen-Hua Li,
  • Chih-Dong Yang,
  • Chung-Hsiang Liu,
  • Chih-Hung Chen,
  • Jau-Jiuan Sheu,
  • Shinn-Kuang Lin,
  • An-Chih Chen,
  • Ping-Kun Chen,
  • Po-Lin Chen,
  • Chung-Hsin Yeh,
  • Jiunn-Rong Chen,
  • Yu-Jen Hsiao,
  • Ching-Huang Lin,
  • Shih-Pin Hsu,
  • Tsang-Shan Chen,
  • Sheng-Feng Sung,
  • Shih-Chieh Yu,
  • Chih-Hsin Muo,
  • Chi Pang Wen,
  • Fung-Chang Sung,
  • Jiann-Shing Jeng,
  • Chung Y Hsu,
  • Taiwan Stroke Registry Investigators

DOI
https://doi.org/10.1371/journal.pone.0171379
Journal volume & issue
Vol. 12, no. 4
p. e0171379

Abstract

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The relationship between cholesterol level and hemorrhagic stroke is inconclusive. We hypothesized that low cholesterol levels may have association with intracerebral hemorrhage (ICH) severity at admission and 3-month outcomes. This study used data obtained from a multi-center stroke registry program in Taiwan. We categorized acute spontaneous ICH patients, based on their baseline levels of total cholesterol (TC) measured at admission, into 3 groups with 200 mg/dL of TC. We evaluated risk of having initial stroke severity, with National Institutes of Health Stroke Scale (NIHSS) >15 and unfavorable outcomes (modified Rankin Scale [mRS] score >2, 3-month mortality) after ICH by the TC group. A total of 2444 ICH patients (mean age 62.5±14.2 years; 64.2% men) were included in this study and 854 (34.9%) of them had baseline TC 15), with an adjusted odds ratio [aOR] of 1.80; 95% confidence interval [CI], 1.41-2.30), and 3-month mRS >2 (aOR, 1.41; 95% CI, 1.11-1.78) using patients with TC >200 mg/dL as reference. Those with TC >160 mg/dL and body mass index (BMI) <22 kg/m2 had higher risk of 3-month mortality (aOR 3.94, 95% CI 1.76-8.80). Prior use of lipid-lowering drugs (2.8% of the ICH population) was not associated with initial severity and 3-month outcomes. A total cholesterol level lower than 160 mg/dL was common in patients with acute ICH and was associated with greater neurological severity on presentation and poor 3-month outcomes, especially with lower BMI.