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Background <p>Post-stroke depression (PSD) is a common, impactful complication of stroke, yet clinically applicable early prediction tools remain limited. The ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL) integrates atherogenic burden and neuroprotective reserve, making it a promising candidate for PSD risk stratification. However, its association with 90-day PSD and utility in predictive models remain unestablished.</p> Methods <p>The primary endpoint was PSD at 90 days after stroke. Multivariable logistic regression assessed TC/HDL–PSD association, and restricted cubic spline (RCS) analysis tested non-linearity. A nomogram was constructed and internally validated, with its performance assessed using decision curve, calibration curves, and receiver operating characteristic analysis.</p> Results <p>Thirty-five point seven percent of patients developed PSD. TC/HDL was an independent predictor of PSD (OR = 1.2726, <i>P</i> = 0.0028), with a linear relationship (no nonlinearity; <i>P</i> = 0.879). The highest TC/HDL quartile correlated with a 136.26% increased PSD risk (OR = 2.3626, <i>P</i> = 0.0190). The nomogram, incorporating TC/HDL, NIHSS, MoCA, sex, and neutrophil count, demonstrated good discrimination and calibration.</p> Conclusions <p>Admission TC/HDL is an independent prognostic marker of 90-day PSD, with a linear dose-response relationship. The internally validated nomogram may assist in risk estimation. However, its clinical applicability remains to be established and requires external validation. Given that TC/HDL is a simple, widely available and low-cost biomarker, these findings may support early risk stratification and preventive psychological care in routine stroke management, particularly in resource-limited clinical settings.</p>

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The total cholesterol to high-density lipoprotein cholesterol ratio predicts post-stroke depression: linear association and individualized risk nomogram

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月2日

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  • Xiangqi Kong,
  • Haobo Wang,
  • Xinyue Yuan,
  • Mina Zhao,
  • Wei Jing

摘要

Background

Post-stroke depression (PSD) is a common, impactful complication of stroke, yet clinically applicable early prediction tools remain limited. The ratio of total cholesterol to high-density lipoprotein cholesterol (TC/HDL) integrates atherogenic burden and neuroprotective reserve, making it a promising candidate for PSD risk stratification. However, its association with 90-day PSD and utility in predictive models remain unestablished.

Methods

The primary endpoint was PSD at 90 days after stroke. Multivariable logistic regression assessed TC/HDL–PSD association, and restricted cubic spline (RCS) analysis tested non-linearity. A nomogram was constructed and internally validated, with its performance assessed using decision curve, calibration curves, and receiver operating characteristic analysis.

Results

Thirty-five point seven percent of patients developed PSD. TC/HDL was an independent predictor of PSD (OR = 1.2726, P = 0.0028), with a linear relationship (no nonlinearity; P = 0.879). The highest TC/HDL quartile correlated with a 136.26% increased PSD risk (OR = 2.3626, P = 0.0190). The nomogram, incorporating TC/HDL, NIHSS, MoCA, sex, and neutrophil count, demonstrated good discrimination and calibration.

Conclusions

Admission TC/HDL is an independent prognostic marker of 90-day PSD, with a linear dose-response relationship. The internally validated nomogram may assist in risk estimation. However, its clinical applicability remains to be established and requires external validation. Given that TC/HDL is a simple, widely available and low-cost biomarker, these findings may support early risk stratification and preventive psychological care in routine stroke management, particularly in resource-limited clinical settings.