Elevated Neutrophil-to-Albumin Ratio Predicts a higher risk of Hematoma Expansion and poor clinical outcomes in Intracerebral Hemorrhage

Objective Intracerebral hemorrhage (ICH) is a common cerebrovascular disease and inflammatory response serves as a critical role in hematoma expansion (HE) following ICH. Neutrophil-to-albumin ratio (NAR) is a readily available and effective biomarker of inflammation used to assess cerebrovascular disease prognosis. However, the correlation of plasma NAR levels with the HE risk and clinical outcome in ICH patients remains underexplored. Materials and methods We recruited 367 ICH patients and 300 healthy controls in this study. Propensity score matching (PSM) was used at a 1:3 ratio to create a HE group (n = 64) and a highly comparable non-HE group (n = 209). Plasma neutrophil count and albumin levels at emergency admission were measured to calculate NAR levels. Univariable and multivariable logistic regression analyses were used to determine the independent risk factors of HE following ICH, and the predictive value of NAR levels in HE was performed using receiver operating characteristic (ROC) curve analysis. The hematoma volume, the National Institutes of Health Stroke Scale (NIHSS) score, and the Glasgow Coma Scale (GCS) score were used to evaluate the neurological deficit following ICH. Spearman’s rank correlation analysis was employed to determine the independent relation of NAR levels to hemorrhagic severity and clinical outcomes in ICH patients. Results We observed a significant elevation in NAR levels among patients with ICH compared to healthy controls (0.16 ± 0.07 vs . 0.08 ± 0.03, p  < 0.0001). After matching, there was no significant difference in the demographic data of the patients in the two groups, while the NAR levels in the HE group was significantly higher than that in the non-HE group (0.91 ± 0.24 vs . 0.83 ± 0.20, p  < 0.05). Moreover, multivariate logistic regression analysis revealed that NAR levels is an independent risk factor for HE following ICH (OR, 8.12; 95% CI, 2.24–30.9; p  < 0.01). Meanwhile, the ROC curve analysis showed a positive increase in HE risk with higher NAR levels, and NAR had an area under the curve (AUC) of 0.599 (95% CI, 0.52–0.67) for predicting HE following ICH. Furthermore, we also found that elevated NAR levels are closely related to the hemorrhagic severity following ICH, and NAR levels demonstrates a positive correlation with the hematoma volume ( r  = 0.114, p  < 0.05) and the NIHSS scores ( r  = 0.170, p  < 0.01), while exhibits an inverse correlation with the GCS scores ( r = -0.187, p  < 0.001). Conclusion NAR levels were significantly elevated in ICH patients with HE and functioned as an independent predictor of HE following ICH. Moreover, NAR levels also showed a positive correlation with disease severity in ICH patients.Therefore, our findings provided a novel biomarker for HE and clinical outcome of this disease.