Joint high level of low-density lipoprotein and high-sensitivity C-reactive protein are associated with early neurological deterioration after thrombolysis in patients with mild stroke

Abstract

Low-density lipoprotein (LDL) and high-sensitivity C-reactive protein (hs-CRP) play important roles in cardiovascular and cerebrovascular diseases through pathways such as inflammation and oxidative stress. We aimed to explore whether LDL and hs-CRP were associated with early neurological outcome after thrombolysis in patients with mild stroke. We studied patients with mild stroke who received intravenous alteplase at the emergency department from April 1, 2017 to April 1, 2024. LDL and hs-CRP levels were measured after thrombolysis through the first blood draw after emergency admission to the neurology department. Patients were divided into 4 groups according to different combinations of LDL (LDL ≤ 3.16 mmol/L, LDL > 3.16 mmol/L) and hs-CRP (hs-CRP ≤ 5 mg/L, hs-CRP > 5 mg/L) levels. Early neurological deterioration (END) was defined as an increase of 2 or more points in NIHSS score at 24 h of thrombolysis. Logistic regression was used to investigate the association of LDL and hs-CRP with early neurological deterioration after thrombolysis in patients with mild stroke. We conducted subgroup analyses based on the following variables: gender, age, NIHSS score at admission, TOAST type, and DWI-defined cerebral infarction area after adjusting for confounding factors. In addition, We conducted three sensitivity analyses by changing the cutoff values of LDL and hs-CRP to enhance the robustness of the findings. This observational study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Among 625 patients (410 men; mean age, 68 (58, 76) years) included in this study, 80 (13%) had early neurological deterioration. Compared with patients with LDL ≤ 3.16 mmol/L, hs-CRP ≤ 5 mg/L, Mild stroke patients with LDL > 3.16 mmol/L and hs-CRP > 5 mg/L had an increased risk of early neurological deterioration (OR, 3.62 [95% CI, 1.49–8.19]) after thrombolysis, and this association persisted after adjustment for confounders (OR, 2.98 [95% CI, 1.11–7.63]). Joint high levels of LDL and hs-CRP were associated with early neurological deterioration after thrombolysis in patients with mild stroke. It can help neurologists better assess the treatment outcomes of patients with mild strokes after thrombolysis. Preparations can be made for remedial measures in the early stages.