The purpose of this study was to examine the relationship between monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and poor short-term 3-month and long-term 6-month prognosis after intravenous thrombolysis in patients with acute ischaemic stroke.

Material and methods:
By retrospective analysis, 763 eligible patients with acute ischaemic stroke with intravenous thrombolysis were included in the study, and the general data and clinical laboratory examination results of the patients were collected. The relationship between MHR and poor prognosis at 3 and 6 months in patients with intravenous thrombolysis was derived by stepwise regression using the R language, followed by 1:1 propensity score matching to determine the MHR threshold and to investigate the relationship between high and low MHR values and poor prognosis.

MHR level was found to predict the prognosis of intravenous thrombolysis patients with acute ischaemic stroke, and it was an effective predictor of poor prognosis at 3 and 6 months after intravenous thrombolysis. MHR has a threshold of 0.584. High MHR levels were strongly associated with a poor 3-month prognosis of intravenous thrombolysis in patients with acute ischaemic stroke (OR = 5.657; 95% CI: 4.124–7.762; p < 0.001). High MHR level was closely associated with poor prognosis of acute ischaemic stroke patients with intravenous thrombolysis at 6 months (OR = 4.923; 95% CI: 3.603–6.726; p < 0.001).

MHR level is a valid predictor for poor prognosis at 3-6 months after intravenous thrombolysis in patients in acute ischaemic stroke.

Zhu H, Hu S, Li Y, et al. Interleukins and ischemic stroke. Front Immunol 2022; 13: 828447.
Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med 2020; 48: 1654-63.
Du H, Lei H, Ambler G, et al. Intravenous thrombolysis before mechanical thrombectomy for acute ischemic stroke: a meta-analysis. J Am Heart Assoc 2021; 10: e022303.
Tsivgoulis G, Katsanos AH, Sandset EC, et al. Thrombolysis for acute ischaemic stroke: current status and future perspectives. Lancet Neurol 2023; 22: 418-29.
Qiu L, Fu F, Zhang W, He J, Zhan Z, Cheng Z. Prevalence, risk factors, and clinical outcomes of remote intracerebral hemorrhage after intravenous thrombolysis in acute ischemic stroke: a systematic review and meta-analysis. J Neurol 2023; 270: 651-61.
Frostegård J. Immunity, atherosclerosis and cardiovascular disease. BMC Med 2013; 11: 117.
Libby P. The changing landscape of atherosclerosis. Nature 2021; 592: 524-33.
Endres M, Moro MA, Nolte CH, Dames C, Buckwalter MS, Meisel A. Immune pathways in etiology, acute phase, and chronic sequelae of ischemic stroke. Circ Res 2022; 130: 1167-86.
Hu J, Xi D, Zhao J, et al. High-density lipoprotein and inflammation and its significance to atherosclerosis. Am J Med Sci 2016; 352: 408-15.
Villanueva DLE, Tiongson MD, Ramos JD, Llanes EJ. Monocyte to high-density lipoprotein ratio (MHR) as a predictor of mortality and major adverse cardiovascular events (MACE) among ST elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention: a meta-analysis. Lipids Health Dis 2020; 19: 55.
Bolayir A, Gokce SF, Cigdem B, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol 2018; 52: 150-5.
Bi X, Liu X, Cheng J. Monocyte to high-density lipoprotein ratio is associated with early neurological deterioration in acute isolated pontine infarction. Front Neurol 2021; 12: 678884.
Zhang Y, Li S, Guo YL, et al. Is monocyte to HDL ratio superior to monocyte count in predicting the cardiovascular outcomes: evidence from a large cohort of Chinese patients undergoing coronary angiography. Ann Med 2016; 48: 305-12.
Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24: 35-41.
Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017-25.
Yoshimura S, Sakai N, Yamagami H, et al. Endovascular therapy for acute stroke with a large ischemic region. N Engl J Med 2022; 386: 1303-13.
Ball SL, Newbould J, Corbett J, Exley J, Pitchforth E, Roland M. Qualitative study of patient views on a ‘telephone-first’ approach in general practice in England: speaking to the GP by telephone before making face-to-face appointments. BMJ Open 2018; 8: e026197.
Fan J, Watanabe T. Atherosclerosis: known and unknown. Pathol Int 2022; 72: 151-60.
Kong P, Cui ZY, Huang XF, Zhang DD, Guo RJ, Han M. Inflammation and atherosclerosis: signaling pathways and therapeutic intervention. Signal Transduct Target Ther 2022; 7: 131.
Ugovšek S, Zupan J, Rehberger Likozar A, Šebeštjen M. Influence of lipid-lowering drugs on inflammation: what is yet to be done? Arch Med Sci 2021; 18: 855-69.
Kim KW, Ivanov S, Williams JW. Monocyte recruitment, specification, and function in atherosclerosis. Cells 2020; 10: 15.
Blank-Stein N, Mass E. Macrophage and monocyte subsets in response to ischemic stroke. Eur J Immunol 2023; 53: e2250233.
von Eckardstein A, Nordestgaard BG, Remaley AT, Catapano AL. High-density lipoprotein revisited: biological functions and clinical relevance. Eur Heart J 2023; 44: 1394-407.
Jia C, Anderson JLC, Gruppen EG, et al. High-density lipoprotein anti-inflammatory capacity and incident cardiovascular events. Circulation 2021; 143: 1935-45.
Plubell DL, Fenton AM, Rosario S, et al. High-density lipoprotein carries markers that track with recovery from stroke. Circ Res 2020; 127: 1274-87.
Barrett TJ. Macrophages in atherosclerosis regression. Arterioscler Thromb Vasc Biol 2020; 40: 20-33.
Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340: 115-26.
Lakhan SE, Kirchgessner A, Tepper D, Leonard A. Corrigendum: matrix metalloproteinases and blood-brain barrier disruption in acute ischemic stroke. Front Neurol 2018; 9: 202.
Rader DJ, Alexander ET, Weibel GL, Billheimer J, Rothblat GH. The role of reverse cholesterol transport in animals and humans and relationship to atherosclerosis. J Lipid Res 2009; 50 Suppl: S189-94.
Rong JX, Berman JW, Taubman MB, Fisher EA. Lysophosphatidylcholine stimulates monocyte chemoattractant protein-1 gene expression in rat aortic smooth muscle cells. Arterioscler Thromb Vasc Biol 2002; 22: 1617-23.
Sanossian N, Saver JL, Navab M, Ovbiagele B. High-density lipoprotein cholesterol: an emerging target for stroke treatment. Stroke 2007; 38: 1104-9.
Kanbay M, Solak Y, Unal HU, et al. Monocyte count/HDL cholesterol ratio and cardiovascular events in patients with chronic kidney disease. Int Urol Nephrol 2014; 46: 1619-25.
Jiang M, Yang J, Zou H, Li M, Sun W, Kong X. Monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) and the risk of all-cause and cardiovascular mortality: a nationwide cohort study in the United States. Lipids Health Dis 2022; 21: 30.
Wang HY, Shi WR, Yi X, Zhou YP, Wang ZQ, Sun YX. Assessing the performance of monocyte to high-density lipoprotein ratio for predicting ischemic stroke: insights from a population-based Chinese cohort. Lipids Health Dis 2019; 18: 127.
Xu Q, Wu Q, Chen L, et al. Monocyte to high-density lipoprotein ratio predicts clinical outcomes after acute ischemic stroke or transient ischemic attack. CNS Neurosci Ther 2023; 29: 1953-64.
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