Once again, useless predictions of recovery rather than delivering EXACT RECOVERY PROTOCOLS that get survivors recovered! I'd have you all fired for incompetence!
Remnant cholesterol inflammatory index, calculated from residual cholesterol to C-reactive protein ratio, and stroke outcomes: a retrospective study using the National institutes of health stroke scale and modified Rankin scale
Lipids in Health and Disease 24, Article number: 228 (2025)
Abstract
Background
Globally, acute ischemic stroke (AIS) persists as a significant driver of both mortality and prolonged disability. Reliable biomarkers for predicting stroke outcomes must be identified to improve clinical decision-making. Residual cholesterol (RC) and RC inflammatory index (RCII) have been proposed as potential biomarkers, although their precise prognostic significance in stroke remains unclear. This research sought to examine the predictive value of RCII and RC in estimating extent of neurological impairment, assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional recovery, evaluated using the three-month modified Rankin Scale (mRS), among individuals diagnosed with AIS.
Methods
The study enrolled 775 individuals diagnosed with AIS. RC and RCII were derived and subsequently grouped into quartiles for analysis. The associations between RCII, RC, NIHSS, and the three-month mRS were investigated using multivariable logistic regression analysis. Subpopulation analysis, inflection point analysis, generalized additive models (GAM), and receiver operating curve (ROC) analyses were utilized to evaluate the ability of these biomarkers to predict outcomes and to identify their optimal cutoff points.
Results
RCII demonstrated a significant relationship with unfavorable functional prognosis, with participants belonging to the top quartile of RCII levels having almost double the risk of poor outcomes(The goal is to prevent these poor outcomes; that's why you're being fired!) compared to those in the lowest quartile. (odds ratio [OR] = 1.98, 95% confidence interval [CI]; 1.20–3.26, P = 0.0071). RC showed no significant association with the NIHSS or three-month mRS (P > 0.05). ROC analysis demonstrated that the RCII exhibited moderate discriminatory power in predicting poor three-month outcomes (AUC = 0.641, 95% CI; 0.595–0.688), whereas RC demonstrated modest predictive performance (AUC = 0.519, 95% CI; 0.475–0.564, P = 0.0018). GAM analysis revealed a J-shaped relationship for RCII, with optimal thresholds of 2.47 for NIHSS and 0.45 for three-month mRS, indicating significant associations above these cutoffs. The subgroup analysis showed stronger associations for RCII in men, smokers, and individuals with hypertension, but no significant associations were found for RC in any subgroup.
Conclusion
The RCII serves as an independent predictor of unfavorable three-month prognoses among individuals diagnosed with AIS. As a composite biomarker combining lipid and inflammatory factors, the RCII can enhance early risk stratification and guide personalized prognostic prediction in Acute stroke management.
Introduction
AIS continues to be a leading contributor to both death and long-lasting disability around the globe. with considerable variability in patient recovery even under standardized treatment. This heterogeneity underscores the need for early, reliable predictors of stroke prognosis to guide clinical decision-making and secondary prevention strategies [1].
Residual cholesterol (RC) = total cholesterol (TC) - high-density lipoprotein cholesterol (HDL-C) - low-density lipoprotein cholesterol (LDL-C) [2] is a lipid component that reflects triglyceride-rich lipoproteins. Emerging studies suggest that RC may be associated with vascular risk, independent of traditional lipid indices [2,3,4]. Interestingly, some recent findings reveal a paradoxical association between higher RC levels and better outcomes in acute ischemic settings, possibly due to its relationship with metabolic reserves or nutritional status [5,6,7].
Moreover, C-reactive protein (CRP) functions as a widely accepted marker reflecting systemic inflammatory status [8]. Several investigations have demonstrated a link between increased CRP levels and adverse clinical outcomes, infarct volume, and stroke severity [9, 10]. However, neither RC nor CRP alone fully reflects the interplay between lipid metabolism and inflammation, which are two processes that jointly influence stroke pathophysiology.
Recently, the RC inflammatory index (RCII) has been introduced as a combined marker that reflects lipid profile and inflammation status. While the RCII has demonstrated potential prognostic significance in cardiovascular diseases [11, 12], its utility in predicting stroke outcomes remains unclear. This novel composite marker may offer a more comprehensive and reliable tool for predicting stroke prognosis than RC or CRP alone as it accounts for lipid metabolism and systemic inflammation, which are integral to stroke pathophysiology.
The association of RCII with stroke severity and clinical outcomes after acute ischemic stroke was evaluated in this study. Specifically, this study investigated the connection between the RCII and stroke severity upon admission, along with functional status at three months. RCII may offer added prognostic value over RC or CRP alone and help identify patients at a higher risk for poor recovery. This study adds to the current knowledge by presenting RCII as a novel composite biomarker for stroke prognosis, integrating lipid metabolism and inflammation for better stroke prediction.
Methods
Research methodology and subjects
The analysis included 775 patients. The inclusion criteria were the following: (1) confirmed acute ischemic stroke (AIS) within 24 h after symptom onset, with the diagnosis established based on World Health Organization (WHO) criteria and further verified by MRI. (2) 18 years of age or above (3) Patients with a documented history or current evidence of any infectious disease upon admission, as well as those missing CRP, total cholesterol, LDL-C, or HDL-C data required for RCII calculation, were excluded from the study.
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