Table 1_The WBC/HDL ratio outperforms other lipid profiles in predicting mortality among ischemic stroke patients: a retrospective cohort study using MIMIC-IV data.docx

ObjectiveTo 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.
MethodsA 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.
ResultsTraditional 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.
InterpretationThe 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.

研究目的：本研究旨在评估血脂谱及其比值，尤其是白细胞与高密度脂蛋白（white blood cell to high-density lipoprotein, WBC/HDL）比值，对入住重症监护病房（intensive care unit, ICU）的缺血性脑卒中患者28天及1年全因死亡率的预测预后价值。
研究方法：本研究采用回顾性队列研究设计，使用MIMIC-IV ICU数据库，纳入2894例缺血性脑卒中患者。对血脂谱（包括总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白）及其衍生比值进行分析。采用校正了人口学与临床因素的Cox比例风险模型评估其与死亡率的关联。通过限制性立方样条分析与Kaplan–Meier生存分析，探究WBC/HDL比值与死亡风险之间的关系。
研究结果：传统血脂谱及其比值与28天或1年死亡率无显著关联。与之相反，升高的WBC/HDL比值与两个时间节点的死亡风险升高均独立相关：28天（风险比：2.198；95%置信区间：1.864–3.225）及1年（风险比：3.163；95%置信区间：2.947–3.334）。限制性立方样条分析显示WBC/HDL比值与死亡风险呈线性关系，而Kaplan–Meier分析则表明，WBC/HDL比值较高的患者生存结局显著更差。
研究阐释：WBC/HDL比值是入住ICU的缺血性脑卒中患者死亡预后的优质标志物，其效能优于传统血脂谱。将该指标纳入临床实践，可强化早期风险分层并指导针对性干预措施。