Lai Suzhen, Wang Chaoying, Lin Yizhao, Kang Baocai, Wang Jianqun, Meng Han, Cao Chunjuan
Department of Imaging, Dehua County Hospital, Quanzhou, China.
Department of Neurosurgery, Dehua County Hospital, Quanzhou, China.
Neurosurg Rev. 2025 Jun 30;48(1):533. doi: 10.1007/s10143-025-03682-z.
The neutrophil to high-density lipoprotein cholesterol ratio (NHR) is a novel inflammatory-metabolic biomarker that reflects the dynamic interplay between systemic inflammation and lipid-mediated vascular protection. While elevated NHR has been linked to the incidence and prognosis of acute ischemic stroke, its association with early hematoma expansion (HE) in spontaneous intracerebral hemorrhage (sICH) remains unclear.
Demographic data, clinical characteristics, laboratory values, and functional outcomes of patients diagnosed with sICH were retrospectively collected and analyzed. NHR levels were calculated at admission and categorized into tertiles. Multivariate logistic regression was conducted to identify independent predictors of early HE. Weighted logistic regression, restricted cubic spline (RCS) models, and propensity score matching (PSM) were employed to estimate the association between NHR and early HE.
A total of 433 patients were included, of whom 13.86% experienced early HE. The incidence of HE increased significantly across NHR tertiles, reaching 22.60% in the highest NHR tertile versus 5.56% in the lowest tertile (P < 0.001). In the adjusted model, patients with sICH in the highest tertile had a 4.76-fold increased risk of early HE (odds ratio = 4.76; 95% confidence interval 2.04-11.11, P < 0.001) compared to those in the lowest tertile. RCS analysis demonstrated a linear relationship between NHR and early HE (nonlinearity P > 0.05). Subgroup analyses confirmed the robustness of this association persisted across different groups (all P for interactions> 0.05). Upon achieving covariate balance through PSM, the positive association between NHR and early HE was further supported. Additionally, higher NHR levels were consistently associated with poorer functional outcomes at 90 days before and after PSM.
Elevated NHR upon admission is independently associated with early HE and unfavorable 90-day outcomes in patients with sICH. As a simple, cost-effective, and readily available biomarker, NHR may offer value in early risk stratification and individualized clinical decision-making in the acute management of sICH.
中性粒细胞与高密度脂蛋白胆固醇比值（NHR）是一种新型的炎症代谢生物标志物，反映了全身炎症与脂质介导的血管保护之间的动态相互作用。虽然NHR升高与急性缺血性卒中的发病率和预后有关，但其与自发性脑出血（sICH）早期血肿扩大（HE）的关系仍不清楚。
回顾性收集并分析诊断为sICH患者的人口统计学数据、临床特征、实验室检查值和功能结局。入院时计算NHR水平并分为三分位数。进行多因素逻辑回归以确定早期HE的独立预测因素。采用加权逻辑回归、限制性立方样条（RCS）模型和倾向评分匹配（PSM）来评估NHR与早期HE之间的关联。
共纳入433例患者，其中13.86%发生早期HE。HE的发生率在NHR三分位数间显著增加，最高NHR三分位数组为22.60%，而最低三分位数组为5.56%（P<0.001）。在调整模型中，最高三分位数的sICH患者发生早期HE的风险比最低三分位数的患者增加4.76倍（比值比=4.76；95%置信区间2.04-11.11，P<0.001）。RCS分析显示NHR与早期HE之间存在线性关系（非线性P>0.05）。亚组分析证实这种关联在不同组中均持续存在（所有交互作用P>0.05）。通过PSM实现协变量平衡后，进一步支持了NHR与早期HE之间的正相关关系。此外，在PSM前后，较高的NHR水平始终与90天时较差的功能结局相关。
入院时NHR升高与sICH患者早期HE及90天不良结局独立相关。作为一种简单、经济有效且易于获得的生物标志物，NHR可能在sICH急性管理的早期风险分层和个体化临床决策中具有价值。
