This study aimed to determine the relationship between the total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) ratio and adverse outcomes in patients with first-ever ischemic stroke (IS), and to validate its potential as a prognostic indicator.

A dual-cohort study integrating retrospective and prospective designs was conducted. The retrospective cohort included 45,162 patients with first-ever IS, and the prospective cohort comprised an independent sample of 2151 patients with first-ever IS. The primary outcome was a composite of stroke recurrence or all-cause death within five years. In the retrospective cohort, logistic regression and regression discontinuity design (RDD) were used to assess the relationship between TC/HDL-C ratio and adverse outcomes, adjusting for confounding factors (e.g., age, sex, comorbidities, and medication use). In the prospective cohort, logistic regression was employed to validate the association, with Kaplan-Meier survival analysis used to characterize prognosis across TC/HDL-C subgroups. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

In the retrospective cohort, a higher TC/HDL-C ratio was identified as an independent risk factor for Five-year adverse outcomes (univariate analysis: OR 1.35 (95% CI, 1.28–1.42), P < 0.001; multivariate analysis: OR 1.30 (95% CI, 1.22–1.39), P < 0.001), and this association was confirmed by RDD. In the prospective cohort, logistic regression replicated these findings, with each unit increase in TC/HDL-C associated with a 12% higher risk of adverse outcomes [OR 1.12 (95% CI, 1.02–1.23), P < 0.05]. Kaplan-Meier analysis further showed that patients with lower TC/HDL-C ratios had significantly longer event-free survival over the 5-year follow-up (log-rank P < 0.001).

Elevated TC/HDL-C ratio is independently associated with an increased risk of stroke recurrence or death within 5 years in patients with first-ever IS. These findings support the utility of the TC/HDL-C ratio as a clinically relevant prognostic marker for long-term outcomes in IS patients.

Acute spontaneous intracerebral hemorrhage (ICH) is a life-threatening condition, and certain serological indicators may be associated with the prognosis after ICH. This study investigated the relationship between N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) and other serological indicators with prognosis 90 days after the onset of acute ICH.

The general information, clinical, and follow-up data of patients with ICH who were admitted to the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2019 to September 2022 were retrospectively collected. Based on the modified Rankin Scale (mRS) at 90 days of onset, the patients were divided into poor prognosis group (mRS > 3) and good prognosis group (mRS ≤ 3), and the differences in various indicators between these two groups were compared. Serological indicators related to prognosis were determined by univariate and multivariate logistic regression analysis, and the predictive value was evaluated by receiver operating characteristic (ROC) analysis and decision curve analysis (DCA).

A total of 121 patients with ICH were included in the study with 49 patients having a good prognosis and 72 patients having a poor prognosis. Multivariate logistic regression analysis showed that NT-pro-BNP at admission was associated with prognosis at 90 days after ICH onset (P < 0.05). ROC and DCA analyses demonstrated that NT-pro-BNP had a certain predictive ability for ICH prognosis.

The level of NT-pro-BNP at admission may be an independent risk factor for predicting prognosis at 90 days after the onset of ICH. The higher the level, the worse the prognosis may be.