Neutrophil-to-High density lipoprotein cholesterol ratio predicts early hematoma expansion in patients with spontaneous intracerebral hemorrhage.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.