Lowserum ldl cholesterol level strongly predicts early hematoma growth, early neurological deterioration and 90-day mortality after acute intracerebral hemorrhage

Abstract

Background: Although low serum LDL cholesterol (LDL-C) levels have been associated with worse clinical outcome after intracerebral hemorrhage (ICH), their relationship with early hematoma growth (EHG) remains unknown. We investigate the relationship between LDL-C levels, EHG and clinical outcome in patients with acute ICH. Methods: We prospectively studied 95 consecutive non-anticoagulated patients with spontaneous supratentorial ICH presenting within 6h from symptoms onset. NIHSS score was measured at baseline and 24h. Baseline laboratory variables including lipid profile were obtained 30% or >6mL, >33%, and >50%) for significant EHG were used. 90-day mortality was recorded. Results: Mean age 70.5 years; 60% male. Median baseline NIHSS score 16. LDL-C: 106 (mean value in mg/dL). Mean hematoma volume on baseline CT 25.6 mL. EHG >30%-6mL occurred in 27 patients (33.3%), >33% in 22 (27.2%), and >50% in 15 (18.5%). Early neurological deterioration (END) occurred in 20 patients (21.1%), and 90-day mortality was 26%. Lower LDL-C levels were significantly associated with EHG (>30%-6mL: 90.7 vs. 116.4, p33%: 94.8 vs. 112.5, p=0.012; >50%: 93.3 vs. 110.9, p=0.029), END (88.3 vs. 108.4, p=0.038), and 90-day mortality (87.9 vs. 108.7, p=0.020). An inverse correlation was found between LDL-C and EHG (r -0.367, p=0.001). LDL-C level improved the accuracy of SS in predicting EHG and outcome (Table). In multivariable logistic regression analysis LDL-C level emerged as independent predictor of EHG (LDL-C<94.5: OR 8.6, 95% CI 2.2-32.7, p=0.002), END (LDL-C<93: OR 14.4, 95% CI 1.4-148.5, p=0.025), and 90-day mortality (LDL-C<100.5: OR 14.2, 95% CI 1.4-147.1, p=0.026). Conclusion: Low serum LDL-C level predicts independently early hematoma growth, END and 90-day mortality after acute ICH.