Association between lactate-to-albumin ratio and in-hospital mortality in ICU patients with acute ischemic stroke: a retrospective cohort study

 And you think predicting mortality is more important than research to prevent mortality? YOU'RE FIRED!

Association between lactate-to-albumin ratio and in-hospital mortality in ICU patients with acute ischemic stroke: a retrospective cohort study

• 

  Xiaocui Yang

• Y

  Yue Zhang

• M

  Min Ou

• 

  Yiwen Liu *

• West China Hospital, Sichuan University, Chengdu, Sichuan, China

Abstract

Background: 

Early risk stratification is critical for critically ill patients with ischemic stroke. The prognostic value of the lactate-to-albumin ratio (LAR) remains unclear in this population.

Methods: 

This single-center retrospective cohort study enrolled adult ICU patients with ischemic stroke from West China Hospital. LAR was calculated using the first lactate and albumin values on ICU admission. Log-transformed LAR was adopted as the main exposure, and the primary outcome was in-hospital mortality. Multivariable logistic regression, ROC analysis, quartile stratification, subgroup, and sensitivity analyses were performed among 749 patients with complete exposure and outcome data, of whom 576 had complete covariate data and comprised the primary multivariable regression cohort.

Results: 

A total of 749 patients were included, with an in-hospital mortality rate of 30.7%. In complete-case multivariable analysis (N = 576; deaths = 172), log-transformed LAR was independently associated with in-hospital mortality (OR = 1.44, 95%CI: 1.09–1.91, p = 0.010) after full adjustment. Each two-fold increase in LAR was associated with a 29% increase in mortality odds. The highest LAR quartile had a significantly higher mortality risk than the lowest quartile (OR = 2.16, 95%CI: 1.21–3.92). LAR showed modest predictive ability (AUC = 0.628). When modeled as a raw continuous LAR, the direction of association remained consistent but did not reach conventional statistical significance (OR 1.23; 95% CI 0.97–1.56; p = 0.083). Moreover, no significant interaction or non-linearity was found.

Conclusion: 

Elevated LAR is independently linked to higher in-hospital mortality among critically ill ischemic stroke patients. It may serve as a simple adjunctive marker for early risk stratification.

The WBC/HDL ratio outperforms other lipid profiles in predicting mortality among ischemic stroke patients: a retrospective cohort study using MIMIC-IV data

 Does your incompetent? doctor have a solution to this problem or just tell you; you're going to die?

The WBC/HDL ratio outperforms other lipid profiles in predicting mortality among ischemic stroke patients: a retrospective cohort study using MIMIC-IV data

Li Zou^†Dong Sun^†Lei ZhangYu XieRenwei ZhangHuagang LiBitang DanYumin Liu^*Bin Mei^*

• Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China

Objective: To assess the prognostic value of lipid profiles and their ratios, particularly the white blood cell to high-density lipoprotein (WBC/HDL) ratio, for predicting 28-day and 1-year all-cause mortality in ischemic stroke patients admitted to the ICU.

Methods: A retrospective cohort study was conducted using the MIMIC-IV ICU database, including 2,894 ischemic stroke patients. Lipid profiles—including total cholesterol, triglycerides, low-density lipoprotein, and high-density lipoprotein—and derived ratios were analyzed. Associations with mortality were assessed using Cox proportional hazards models adjusted for demographic and clinical factors. Restricted cubic spline and Kaplan–Meier survival analyses were utilized to explore the relationship between the WBC/HDL ratio and mortality risk.

Results: Traditional lipid profiles and their ratios were not significantly associated with 28-day or 1-year mortality. Conversely, an elevated WBC/HDL ratio was independently associated with increased mortality risk at both 28 days (hazard ratio: 2.198; 95% confidence interval: 1.864–3.225) and 1 year (hazard ratio: 3.163; 95% confidence interval: 2.947–3.334). Restricted cubic spline analysis demonstrated a linear relationship between the WBC/HDL ratio and mortality risk, while Kaplan–Meier analyses indicated significantly poorer survival outcomes for patients with higher WBC/HDL ratios.

Interpretation: The WBC/HDL ratio is a superior prognostic marker for mortality in ischemic stroke patients admitted to the ICU, outperforming traditional lipid profiles. Incorporating this measure into clinical practice may enhance early risk stratification and guide targeted interventions.

1 Introduction

Ischemic stroke (IS) is a leading cause of disability and mortality worldwide, imposing a significant burden on patients, families, and healthcare systems (1). Thrombolysis and endovascular embolectomy have significantly improved the prognosis of ischemic stroke patients; however, many patients continue to experience poor outcomes, particularly those requiring intensive care unit (ICU) admission due to severe neurological deficits or medical complications (2). Identifying high-risk patients early remains essential to enhance postoperative management, optimize therapeutic strategies, and allocate resources effectively within the ICU setting.

Lipid metabolism and inflammation are pivotal in the pathogenesis and progression of IS. Dyslipidemia contributes to atherosclerosis and thrombosis, fundamental mechanisms underlying ischemic events (3). Elevated levels of low-density lipoprotein (LDL) and triglycerides (TG), along with decreased high-density lipoprotein (HDL), have been associated with an increased risk of stroke occurrence (4). In parallel, systemic inflammation plays a critical role in neuronal injury and post-stroke recovery, with elevated inflammatory markers correlating with worse outcomes (5, 6).

Given the interconnected roles of lipid metabolism and inflammation in IS, ratios that integrate these parameters have been proposed as comprehensive prognostic markers. Ratios like LDL/HDL, TC/HDL (total cholesterol to HDL ratio), and TG/HDL aim to reflect the balance between pro-atherogenic lipids and protective HDL (7). The white blood cell to HDL ratio (WBC/HDL), in particular, combines systemic inflammation with lipid status, potentially offering a more holistic assessment of risk (8). Prior studies suggest that these composite ratios may hold stronger prognostic value than individual lipid measures in cardiovascular disease (9, 10), yet their predictive utility in ICU-admitted IS patients remains uncertain. Therefore, critical illness and the body’s acute response can change lipid levels and inflammation markers, which may influence their usefulness for predicting outcomes (11, 12). Understanding whether traditional lipid profiles and their ratios can still reliably predict outcomes in this setting is crucial for identifying effective markers to assess risk and guide treatment in the ICU.

Prior studies suggest that these composite ratios may hold stronger prognostic value than individual lipid measures in cardiovascular disease (9, 10), yet their predictive utility in ICU-admitted IS patients remains uncertain. This study therefore aimed to evaluate two critical questions using the MIMIC-IV database (13): first, whether traditional lipid ratios (LDL/HDL, TC/HDL, TG/HDL) retain prognostic value in critically ill stroke patients experiencing acute metabolic disturbances; and second, whether novel ratios integrating systemic inflammation with lipid profiles (e.g., WBC/HDL) could provide enhanced risk stratification in this population. Through this investigation, we sought to establish evidence-based guidance for prognostic marker selection in neurocritical care settings.

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Association of Life’s Crucial 9 with all-cause and cardiovascular mortality in stroke survivors and predictive value for mortality compared with Life’s Essential 8: evidence from NHANES 2005–2018

 NOTHING HERE GETS SURVIVORS RECOVERED! Predicting mortality is the height of stupidity; JUST MAYBE YOU WANT TO PREVENT THAT!

I'd have you all fired!

Association of Life’s Crucial 9 with all-cause and cardiovascular mortality in stroke survivors and predictive value for mortality compared with Life’s Essential 8: evidence from NHANES 2005–2018

Xupeng Wu^1*†Xiaofeng Li^2,3†Hong Liu¹

• ¹Department of Neurology, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, Shanxi, China
• ²The First Clinical Medical College, Shanxi Medical University, Taiyuan, Shanxi, China
• ³Department of General Medicine, Linfen City People’s Hospital, Linfen, Shanxi, China

Background: There is evidence of a positive correlation between depressive disorders and poor cardiovascular health (CVH). Recently, the inclusion of psychological health assessments into Life’s Essential 8 (LE8) has been put forward to enhance the foundation of CVH. We aimed to investigate the probable link between the innovative CVH assessment framework, Life’s Crucial 9 (LC9), and overall mortality as well as mortality associated with cardiovascular disease (CVD) among stroke survivors, while also assessing its prognostic relevance regarding mortality in comparison to LE8.

Methods: This study draws on a cohort of stroke survivors identified from the National Health and Nutrition Examination Survey (NHANES), spanning survey cycles from 2005 to 2018. The LE8 was assessed by the approach recommended by the American Heart Association. The LC9 framework incorporated an additional depression score, measured by Patient Health Questionnaire-9, into the LE8 assessment. To investigate the associations between LE8 and LC9 with all-cause and cardiovascular mortality in stroke survivors, we employed multivariable Cox proportional hazards regression analyses.

Results: After adjusting for covariates, each 10-point increase in LC9 was associated with a 24.5 and 30.1% reduction in all-cause and CVD mortality in stroke survivors, respectively. Participants in the highest quartile (Q4) of LC9 exhibited significantly lower mortality rates compared to those in the lowest quartile (Q1) (all-cause mortality: HR 0.412, p < 0.0001; CVD mortality: HR 0.327, p < 0.001). Similar associations were observed for LE8. Restricted cubic spline analysis indicated that both LC9 and LE8 demonstrated linearly associations with mortality post-stroke. Physical activity score, nicotine exposure score, and blood glucose score were significantly linked to all-cause and CVD mortality in stroke survivors. Adding depression score to LE8 significantly enhanced the prediction of all-cause mortality in stroke survivors (net reclassification improvement index = 9.6%, p = 0.033; ΔC index = 0.002, p = 0.0009; integrated discrimination improvement = 0.01, p = 0.007). The NRI of 9% (p = 0.086) for CVD mortality, while not statistically significant, suggests a trend toward improved classification.

Conclusion: LC9 exhibited both linear and inverse correlations with all-cause and cardiovascular mortality among stroke survivors. Adding a depression score to the LE8 framework may improve the predictive accuracy for all-cause mortality in stroke survivors.

1 Introduction

Stroke, characterized by acute focal neurological deficits, results from various cerebrovascular causes and is primarily categorized into hemorrhagic and ischemic types (1, 2). It presents significant morbidity, mortality, and disability, profoundly affecting individuals, families, and societies (3). The Global Burden of Disease Study 2019 indicates a 70% increase in incident and an 85% rise in prevalent stroke cases over the past 30 years, with significant age-standardized incidence and prevalence rates observed in individuals under 70 (4). Over the next 30 years, stroke mortality is projected to continue to increase by 50%, and disease-adjusted life years are also projected to increase significantly (5). In the United States, the average annual medical cost per stroke patient is approximately $60,000, which is the highest of all countries (6). Despite advancements, gaps remain in current primary stroke prevention services, highlighting the urgent need to identify modifiable and practicable risk factors and foster collaborative multistakeholder efforts to implement effective stroke prevention strategies (5, 7).

Recently, the American Heart Association (AHA) updated and introduced a new tool for cardiovascular health (CVH) assessment and quantification, the Life’s Essential 8 (LE8), based on the previous Life’s Simple 7 (LS7) (8). The LE8 comprehensively evaluates eight evidence-based CVH metrics encompassing four healthy lifestyle (e.g., diet and physical activity [PA]) and four health factors (e.g., blood glucose and blood pressure), representing a new paradigm for CVH assessment (8). Since the introduction of the LE8, numerous population-based observational studies have demonstrated inverse associations between the LE8 score and various adverse health outcomes, including cardiovascular disease (CVD), chronic kidney disease, and non-alcoholic fatty liver disease (9–11). Maintaining a higher CVH has been linked to increased life expectancy and reduced risk of mortality among both men and women compared to low CVH populations (12–14). In addition, while several studies have shown an inverse relationship between the LE8 score and stroke risk, findings remain contentious (15, 16). Importantly, large population-based studies have indicated that maintaining a higher LE8 may narrow socioeconomic health inequalities (13, 17).

The bidirectional association of psychological health, including depression, with CVH is increasingly being recognized. People with CVD are at a higher risk of developing depression compared to the general population, while those with depression are also more prone to developing CVD, creating a negative feedback loop that adversely affects outcomes (18). Notably, several cross-sectional and longitudinal cohort studies have demonstrated a considerable link between CVH, as determined by the LE8 metric, and the prevalence of major depression (19, 20). Thus, in a recently published perspective, Gaffey et al. (21) suggested integrating psychological health (e.g., depression) into the existing LE8 score framework by proposing a new Life’s Crucial 9 (LC9) score. As a foundation for achieving optimal and equitable CVH, psychological health was identified as a possible underpinning for the enhancement of the existing LE8 paradigm and as an important dimension in future integrated models of cardiovascular care (21). A recent prospective cohort investigation demonstrated that LC9 was independently associated with all-cause and cardiovascular mortality among adults in U.S.; however, there was limited improvement in the predictive power of LC9 compared with LE8 for mortality (22). Available observational evidence suggests that higher LE8 is associated with reduced risk of depression and mortality after stroke (23, 24). Nevertheless, the association of LC9 with mortality in stroke survivors remains largely unknown.

This study assessed the longitudinal relationships between LC9 score and all-cause and CVD mortality in stroke survivors, as well as to elucidate whether the predictive power of the LC9 (as compared to the LE8) was improved for mortality after stroke. In summary, our study emphasizes the importance of understanding how LC9 contributes to mortality risk in stroke survivors and evaluates the necessity of incorporating depression assessments into the existing LE8 framework to enhance mortality predictions in this cohort. Given the complex interplay between CVH and mortality in stroke survivors, we conducted stratified analyses to evaluate the impact of demographic variables on these relationships. Additionally, we will evaluate the individual contributions of each LE8/LC9 component score to mortality risk, providing a more nuanced understanding of the factors driving the observed associations.

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The rate-pressure product combined model within 24 h on admission predicts the 30-day mortality rate in conservatively treated patients with intracerebral hemorrhage

 If you're not going to do useful research like delivering recovery or preventing mortality instead of this crapola of predicting failure to recover, I'd suggest getting the hell out of stroke and doing something easier like basket weaving.

The rate-pressure product combined model within 24 h on admission predicts the 30-day mortality rate in conservatively treated patients with intracerebral hemorrhage

Hui ZhengYuguang TangHai ZhouXiang Ji^*

• Department of Neurosurgery, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China

Background and objectives: Recently, some literature has proposed new indicators such as rate-pressure product, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, etc. However, there has been no literature that has utilized these new indicators to establish a predictive model for assessing the risk of mortality in patients within 24 h on admission. Therefore, this study aims to build a predictive model that can rapidly assess the likelihood of mortality in patients within 24 h of admission.

Methods: The datasets used in this study are available from the corresponding author upon reasonable request. Patients were randomly assigned to the training or validation cohort based on a ratio of 7:3, which was implemented as internal validations for the final predictive models. In the training set, least absolute shrinkage and selection operator (LASSO) regression was employed to select predictive factors, followed by both univariate and subsequent multivariate analysis. The predictive ability was assessed by the area under the receiver operating characteristic (ROC) curve.

Results: A total of 428 patients were included in our research. The final model included 4 independent predictors (Glasgow Coma Scale, hematoma volume, rate-pressure product, c-reactive protein) and was developed as a simple-to-use nomogram. The training set and internal validation set model’s C-index are 0.933 and 0.954, demonstrating moderate predictive ability with regard to risks of mortality. Compared to ICH score (AUC: 0.910 and 0.925), the net reclassification index (NRI) is 0.298 (CI = −0.105 to 0.701, p: 0.147) and integrated discrimination improvement (IDI) is 0.089 (CI = −0.049 to 0.228, p: 0.209). Our model is equally excellent as the classic ICH score model.

Conclusion: We developed a model with four independent risk factors to predict the mortality of ICH patients. Our predictive model is effective in assessing the risk of mortality in patients within 24 h on admission, which might be worth considering in clinical settings after further external validation.

The Intracerebral Hemorrhage Score Overestimates Mortality in Young Adults

YOU have to change the mindset of your doctors, researchers and stroke hospital  from the nihilism of failure to recover predictions to: This is how we are going to get you recovered. THIS IS YOUR RESPONSIBILITY,  your stroke medical 'professionals' have abandoned your possibility of recovery, so you just have to accept their failure to do their job. Hope you like your options of disability or death!

The Intracerebral Hemorrhage Score Overestimates Mortality in Young Adults

• Jason Maljaars, MD
• Aayushi Garg, MD
• Vaelan Molian, BS
• Enrique C. Leira, MD, MS
• Harold P. Adams, MD
• Amir Shaban, MD

Published:July 08, 2021DOI:https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105963

Abstract

Objective

To determine whether the intracerebral hemorrhage (ICH) score is accurate in predicting 30-day mortality in young adults, we calculated the ICH score for 156 young adults (aged 18-45) with primary spontaneous ICH and compared predicted to observed 30-day mortality rates.

Methods

We retrospectively reviewed all patients aged 18-45 consecutively presenting to the University of Iowa from 2009 to 2019 with ICH. We calculated the ICH score and recorded its individual subcomponents for each patient. Poisson regression was used to test the association of ICH score components with 30-day mortality.

Results

We identified 156 patients who met the inclusion criteria; mean± standard deviation (SD) age was 35±8 years. The 30-day mortality rate was 15% (n=24). The ICH score was predictive of 30-day mortality for each unit increase (p= 0.04 for trend), but the observed mortality rates for each ICH score varied considerably from the original ICH score predictions. Most notably, the 30-day mortality rates for ICH scores of 1, 2, and 3 are predicted to be 13%, 26%, and 72% respectively, but were observed in our population to be 0%, 3%, and 41%. An ICH volume of >30cc [relative risk (RR) 28, 95% confidence intervals (CI) 3-315, p=0.01] and a GCS score of <5 (RR 13, 95% CI 0.1-1176, p=0.01) were independently associated with 30-day mortality.

Conclusions

The ICH score tends to overestimate mortality in young adults. ICH volume and GCS score are the most relevant items in predicting mortality at 30 days in young adults.(Do you tell your patients you have predicted mortality and have given up on their treatment?)

 

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry

Aren't you just so fucking glad research on predicting death is more important than research on recovery? I'd have choice words for the fuckers that approved this research. First would be: YOU'RE FIRED! The only goal in stroke is 100% recovery, this doesn't meet that goal and if you as a researcher don't see that you don't belong in stroke.

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry

1. Hao Li1,
2. http://orcid.org/0000-0003-4306-0460Shi-sheng Ye1,
3. Yuan-Ling Wu2,
4. Sheng-Ming Huang3,
5. Yong-Xin Li4,
6. Kui Lu5,
7. Jing-Bo Huang1,
8. Lve Chen4,
9. Hong-Zhuang Li4,
10. Wen-Jun Wu5,
11. Zhi-Lin Wu6,
12. Jian-Zhou Wu6,
13. Wang-Tao Zhong7,
14. Wen-Chuan Xian7,
15. Feng Liao7,
16. http://orcid.org/0000-0003-2097-8375Tao-Hsin Tung8,
17. Qiao-Ling Wu1,
18. Hai Chen1,
19. Li Yuan1,
20. Zhi Yang1,
21. Li-An Huang3

1. Correspondence to Dr Li-An Huang; huanglian1306@126.com

Abstract

Objectives We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).

Design Analysis of a multicentre prospective registry.

Setting In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.

Participants 224 patients with AIS were treated by MT.

Results Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.

Conclusions We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.

Trial registration number Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2020-043415