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. 2017 Apr 19;12(4):e0171379.
doi: 10.1371/journal.pone.0171379. eCollection 2017.

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

Yu-Wei Chen  1   2 , Chen-Hua Li  1   2 , Chih-Dong Yang  3 , Chung-Hsiang Liu  4 , Chih-Hung Chen  5 , Jau-Jiuan Sheu  6 , Shinn-Kuang Lin  7 , An-Chih Chen  8 , Ping-Kun Chen  9 , Po-Lin Chen  10 , Chung-Hsin Yeh  11   12   13 , Jiunn-Rong Chen  14 , Yu-Jen Hsiao  15 , Ching-Huang Lin  16 , Shih-Pin Hsu  17 , Tsang-Shan Chen  18 , Sheng-Feng Sung  19 , Shih-Chieh Yu  20 , Chih-Hsin Muo  21 , Chi Pang Wen  22   23 , Fung-Chang Sung  23 , Jiann-Shing Jeng  1   24 , Chung Y Hsu  25 ; Taiwan Stroke Registry Investigators
Affiliations

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

Yu-Wei Chen et al. PLoS One. .

Abstract

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 <160, 160-200 and >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 <160 mg/dL. Patients with TC <160 mg/dL presented more often severe neurological deficit (NIHSS >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.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart for selection of spontaneous ICH patients in the Taiwan Stroke Registry.
ICH: intracerebral hemorrhage; TC: total cholesterol levels.
Fig 2
Fig 2. Correlation between initial NIHSS score (median [interquartile range]) and total cholesterol levels in 2444 ICH patients.
(Pearson correlation coefficient = -0.74, p = 0.009).
Fig 3
Fig 3. Three-month survival in different cholesterol groups in 2444 ICH patients.
See this image and copyright information in PMC

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