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.