Association Between TCBI (Triglycerides, Total Cholesterol, and Body Weight Index) and Stroke-Associated Pneumonia in Acute Ischemic Stroke Patients

Figures & data

Figure 1 Patient flowchart.

Abbreviations: SAP, Stroke-associated pneumonia.

Table 1 Comparison of Baseline Data Between SAP Group and Non-SAP Group

Variables	All Patients n = 962	Non-SAP n = 834	SAP n = 128	P value
Demographic information
Female, n (%)	369 (38.4)	316 (37.9)	53 (41.4)	0.446
Age (years), median (IQR)	68 (59–77)	67 (58–76)	73 (64–81)	<0.001
Height (m), mean ± SD	1.65±0.08	1.65±0.08	1.65±0.07	0.488
Body weight (kg), mean ± SD	68.08±11.22	68.73±11.18	63.88±10.61	<0.001
Hypertension, n (%)	795 (82.6)	691 (82.9)	104 (81.3)	0.656
Diabetes, n (%)	331 (34.4)	285 (34.2)	46 (35.9)	0.696
Coronary heart disease, n (%)	144 (15.0)	117 (14.0)	27 (21.1)	0.037
Atrial fibrillation, n (%)	99 (10.3)	70 (8.4)	29 (22.7)	<0.001
Smoking, n (%)	233 (24.2)	199 (23.9)	34 (26.6)	0.507
Drinking, n (%)	177 (18.4)	157 (18.8)	20 (15.6)	0.384
History of stroke, n (%)	178 (18.5)	148 (17.7)	30 (23.4)	0.123
Clinical features
TOAST classification, n (%)				<0.001
LAA	636 (66.1)	545 (65.3)	91 (71.1)
CE	100 (10.4)	74 (8.9)	26 (20.3)
SAO	226 (23.5)	215 (25.8)	11 (8.6)
NIHSS at admission (score), median (IQR)	2 (1–5)	2 (1–4)	9 (3–17)	<0.001
Dysphagia, n (%)	135 (14.0)	87 (10.4)	48 (37.5)	<0.001
Treatment, n (%)
Endovascular treatment	55 (5.7)	24 (2.9)	31 (24.2)	<0.001
Intravenous thrombolysis	127 (13.2)	105 (12.6)	22 (17.2)	0.153
Antiplatelet drug use	884 (91.9)	771 (92.4)	113 (88.3)	0.108
Anticoagulant drug use	116 (12.1)	91 (10.9)	25 (19.5)	0.005
Lipid-lowering drug use	946 (98.3)	821 (98.4)	125 (97.7)	0.518
Laboratory data
Hemoglobin (g/L), median (IQR)	141 (129–153)	142 (130–153)	137 (122–148)	0.002
Albumin (g/L), mean ± SD	39.55±4.28	39.78±4.19	38.07±4.60	<0.001
TC (mmol/L), median (IQR)	4.36 (3.61–5.02)	4.40 (3.67–5.06)	4.10 (3.31–4.69)	<0.001
TG (mmol/L), median (IQR)	1.25 (0.94–1.78)	1.31 (0.95–1.84)	1.08 (0.82–1.37)	<0.001
LDL-C (mmol/L), mean ± SD	2.66±0.89	2.68±0.87	2.53±1.04	0.076
HDL-C (mmol/L), median (IQR)	1.12 (1.02–1.32)	1.12 (1.02–1.32)	1.13 (1.02–1.36)	0.761
TCBI, median (IQR)	1259.03 (812.18–1942.30)	1322.76 (859.93–2046.42)	898.54 (606.86–1396.16)	<0.001
A^2DS^2 (score), median (IQR)	1 (1–3)	1 (1–2)	5 (3–7)	<0.001

Abbreviations: SD, standard deviation; IQR, interquartile range; SAP, Stroke-associated pneumonia; LAA, Large artery atherosclerosis; CE, Cardioembolism; SAO, Small-artery occlusion; NIHSS, National Institutes of Health Stroke Scale; TC, Total cholesterol; TG, Triglycerides; LDL-C, Low-density lipoprotein cholesterol; HDL-C, High-density lipoprotein cholesterol; TCBI, Triglycerides, total cholesterol, and body weight index.

Table 2 Baseline Characteristics of Patients According to TCBI Tertiles

Variables	TCBI Tertiles			P value
	T1 (<948.33) n=320	T2 (948.33–1647.15) n=321	T3 (>1647.15) n=321
Demographic information
Female, n (%)	134 (41.9)	124 (38.6)	111 (34.6)	0.163
Age (years), median (IQR)	73 (64–81)	66 (59–76)	64 (55–72)	<0.001
Height (m), mean ± SD	1.64±0.08	1.65±0.08	1.66±0.07	<0.001
Body weight (kg), mean ± SD	63.50±9.72	68.73±11.02	72.01±11.21	<0.001
Hypertension, n (%)	251 (78.4)	267 (83.2)	277 (86.3)	0.030
Diabetes, n (%)	99 (30.9)	108 (33.6)	124 (38.6)	0.115
Coronary heart disease, n (%)	68 (21.3)	51 (15.9)	25 (7.8)	<0.001
Atrial fibrillation, n (%)	59 (18.4)	25 (7.8)	15 (4.7)	<0.001
Smoking, n (%)	69 (21.6)	84 (26.2)	80 (24.9)	0.371
Drinking, n (%)	49 (15.3)	65 (20.2)	63 (19.6)	0.214
History of stroke, n (%)	67 (20.9)	54 (16.8)	57 (17.8)	0.372
Clinical features
TOAST classification, n (%)				<0.001
LAA	201 (62.8)	206 (64.2)	229 (71.3)
CE	56 (17.5)	24 (7.5)	20 (6.2)
SAO	63 (19.7)	91 (28.3)	72 (22.4)
NIHSS at admission (score), median (IQR)	3 (1–7)	2 (1–4)	2 (1–4)	0.001
Dysphagia, n (%)	49 (15.3)	41 (12.8)	45 (14.0)	0.651
Treatment, n (%)
Endovascular treatment	24 (7.5)	23 (7.2)	8 (2.5)	0.009
Intravenous thrombolysis	49 (15.3)	28 (8.7)	50 (15.6)	0.015
Antiplatelet drug use	275 (85.9)	302 (94.1)	307 (95.6)	<0.001
Anticoagulant drug use	61 (19.1)	32 (10.0)	23 (7.2)	<0.001
Lipid-lowering drug use	316 (98.8)	314 (97.8)	316 (98.4)	0.644
Laboratory data
Hemoglobin (g/L), median (IQR)	135 (121–147)	142 (129.5–155)	145 (135–156)	<0.001
Albumin (g/L), mean ± SD	38.70±4.46	39.81±4.16	40.14±4.09	<0.001
TC (mmol/L), median (IQR)	3.60 (3.04–4.20)	4.36 (3.73–4.97)	5.00 (4.49–5.67)	<0.001
TG (mmol/L), median (IQR)	0.84 (0.71–1.02)	1.24 (1.10–1.50)	2.04 (1.68–2.86)	<0.001
LDL-C (mmol/L), mean ± SD	2.20 (1.62–2.64)	2.70 (2.20–3.19)	3.02 (2.63–3.64)	<0.001
HDL-C (mmol/L), median (IQR)	1.16 (1.05–1.38)	1.14 (1.02–1.35)	1.07 (0.99–1.22)	<0.001
A^2DS^2 (score), median (IQR)	2 (1–4)	1 (1–3)	1 (1–3)	<0.001
SAP, n (%)	69 (21.6)	39 (12.1)	20 (6.2)	<0.001

Abbreviations: SD, standard deviation; IQR, interquartile range; TCBI, Triglycerides, total cholesterol, and body weight index; LAA, Large artery atherosclerosis; CE, Cardioembolism; SAO, Small-artery occlusion; NIHSS, National Institutes of Health Stroke Scale; TC, Total cholesterol; TG, Triglycerides; LDL-C, Low-density lipoprotein cholesterol; HDL-C, High-density lipoprotein cholesterol; SAP, Stroke-associated pneumonia.

Figure 2 Forest plot of odds ratios for SAP.

Abbreviations: LAA, Large artery atherosclerosis; CE, Cardioembolism; SAO, Small-artery occlusion; NIHSS, National Institutes of Health Stroke Scale; TCBI, Triglycerides, total cholesterol, and body weight index.

Figure 3 Association of TCBI with risk of stroke-associated pneumonia. Odds ratios and 95% confidence intervals derived from restricted cubic spline regression, with knots placed at the 5th, 35th, 65th, and 95th percentiles of the distribution of Log TCBI. The reference point is the median of Log TCBI. Odds ratios were adjusted for the same variables as model in. Figure 2.

Table 3 Comparison of Predictive Power of TCBI Vs Other Indicators in the Prediction of SAP

Variables	AUROC (95% CI)	Cutoff Value	Youden Index	Sensibility (%)	Specificity (%)	Positive Prediction Rate (%)	Negative Prediction Rate (%)	P value
TCBI	0.664 (0.633–0.694)	1112.37	0.2654	65.62	60.91	20.49	92.03	Reference
BW	0.623 (0.591–0.654)	65.30	0.1964	64.84	54.80	18.04	91.04	0.206
TC	0.599 (0.568–0.630)	4.42	0.1767	68.75	48.92	17.05	89.85	0.002
TG	0.628 (0.597–0.659)	1.37	0.2321	76.56	46.64	18.05	92.84	0.003
A^2DS^2	0.819 (0.794–0.843)	2	0.5108	75.78	75.30	32.01	95.30	<0.001
A^2DS^2+TCBI	0.838 (0.813–0.860)	0.1418	0.5485	73.44	81.41	37.75	95.23	<0.001

Abbreviations: SAP, stroke-associated pneumonia; AUROC, Area Under the Receiver Operating Characteristic Curve; TCBI, Triglycerides, total cholesterol, and body weight index; BW, Body weight; TC, Total cholesterol; TG, Triglyceride.

Figure 4 Comparison of AUROC of TCBI with other biomarkers for predicting SAP.

Abbreviations: BW, Body weight; TC, Total cholesterol; TG, Triglycerides; TCBI, Triglycerides, cholesterol, body weight index; SAP, Stroke-associated pneumonia.