Non-HDL/HDL Cholesterol Ratio as a Protective Factor for Functional Recovery Following Intracerebral Hemorrhage: A Prospective Cohort Study

Tong Gu,1 Chuanqin Yu,1 Zhiwen Zha,1 Chen Rao,1 Xuke Zhang,1 Meihai Wen,1 Yucheng Huo,2 Chen He,1 Lei Zhu1 1Department of Neurology, The First Hospital of Anhui University of Science & Technology, Huainan, Anhui, People’s Republic of China; 2Obstetrics and Gynecology, The First Hospital of Anhui University of Science & Technology, Huainan, Anhui, People’s Republic of ChinaCorrespondence: Lei Zhu, Department of Neurology, The First Hospital of Anhui University of Science & Technology, Huainan, Anhui, People’s Republic of China, Email [email protected]: Whether lipid profiles influence functional recovery after intracerebral hemorrhage (ICH) is unclear. This study investigated the association between the non-high-density lipoprotein to high-density lipoprotein cholesterol ratio (NHHR) and 90-day functional outcomes in patients with ICH.Patients and Methods: This single-center, prospective, observational cohort study enrolled 200 patients with acute ICH. Fasting blood samples were collected within 24 hours of admission for lipid profiling, and NHHR was calculated as (total cholesterol high-density lipoprotein cholesterol [HDL-C])/HDL-C. The primary outcome was functional status at 90 days, assessed using the modified Rankin Scale (mRS). Based on the mRS scores, patients were classified into two groups: favorable outcome (mRS ≤ 2, functional independence) and poor outcome (mRS > 2, functional dependence or death).Results: Of the 200 patients, 81 (40.5%) had poor outcomes at 90 days. The poor outcome group exhibited significantly lower baseline NHHR compared to the favorable outcome group (2.54 vs. 2.75, P = 0.002). After multivariable adjustment, a higher NHHR remained independently associated with reduced odds of poor outcome (adjusted odds ratio = 0.608; 95% confidence interval: 0.401– 0.921; P = 0.019). As a standalone predictor, NHHR exhibited high sensitivity (85.2%) but low specificity (39.5%) for predicting poor outcome, with an optimal cutoff of ≤ 3.185. Its discriminative ability was modest (area under the curve [AUC] = 0.590; 95% CI: 0.510– 0.670; P = 0.03 2). However, combining NHHR with the NIHSS score substantially improved prognostic performance (AUC = 0.863; 95% CI: 0.804– 0.923; P < 0.001), an effect that remained stable after internal validation (bootstrap-corrected AUC = 0.851; 95% CI: 0.789– 0.914).Conclusion: A higher baseline NHHR independently predicts favorable 90-day outcomes after ICH, supporting a “protective lipid paradox” distinct from ischemic stroke. As a simple and readily available biomarker, NHHR offers complementary prognostic information to established clinical scales and may aid early risk stratification. Keywords: intracerebral hemorrhage, prognosis, lipid paradox, non-HDL/HDL cholesterol ratio, biomarker