Elevated WBC/HDL Ratio Predicts Poststroke Functional Prognosis

Background Inflammation and lipid metabolism play critical roles in the pathogenesis and outcome of acute ischemic stroke (AIS). The white blood cell to high‐density lipoprotein cholesterol ratio (WBC/HDL) has been identified as a novel composite biomarker reflecting systemic inflammatory status and anti‐inflammatory capacity. We sought to evaluate the prognostic value of WBC/HDL in predicting 90‐day functional outcomes among AIS patients. Methods We retrospectively enrolled 837 AIS patients. Baseline WBC/HDL ratios were calculated at admission. The primary endpoint was 90‐day functional outcome, assessed by the modified Rankin Scale, with scores > 2 defined as unfavorable outcomes. Associations between WBC/HDL and outcomes were assessed through logistic regression, restricted cubic spline (RCS) curves, and subgroup analysis. Results Higher WBC/HDL ratios were significantly associated with poor functional outcomes. The association remained robust after adjustment for key covariates (adjusted OR: 1.2589; p = 0.0001). The highest WBC/HDL tertile had nearly twice the risk of poor outcomes compared with the lowest tertile. The RCS analysis demonstrated a linear dose–response relationship. Subgroup analyses revealed a consistent relationship across sex, stroke severity, and comorbidity groups, without significant interactions. Conclusions The WBC/HDL ratio independently predicts 90‐day functional outcomes in AIS and represents a practical biomarker for early risk stratification.