Monocyte-to-high-density lipoprotein cholesterol ratio predicts hematoma expansion and poor outcomes in patients with spontaneous intracerebral hemorrhage

To explore the predictive capacity of the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for functional outcomes in patients with spontaneous intracerebral hemorrhage (ICH). In the present study, adult patients with ICH admitted to the affiliated hospital of Southwest Medical University between January 2020 and January 2024 were recruited. We collected the clinical, imaging, as well as laboratory test data of patients. Information of hematoma expansion (HE) after ICH onset was obtained, and modified Rankin scale (mRS) scores were applied to assess the clinical outcomes. Multivariable logistic regression models were used to evaluate the association of MHR with HE and clinical outcomes in ICH patients. Receiver operating characteristic (ROC) curve analysis was carried out to determine the optimal cutoff of MHR to predict HE after ICH onset. We included 541 patients with ICH in our investigation. Multivariate logistic regression analysis showed that higher MHR on admission was an independent predictor of HE (p = 0.047). ROC analysis determined 0.275 as the optimal MHR cutoff point for HE prediction. Moreover, multivariate regression analysis demonstrated that MHR ≥ 0.275 was strongly associated with poor one-year prognosis in ICH patients (p = 0.033). Higher MHR is closely correlated with elevated risks of HE and unfavorable ICH prognosis. Our data reveal that MHR could serve as an effective prognostic indicator for ICH. However, due to limitations such as potential selection bias and a modest predictive performance, external validation in a multicenter, large-scale prospective study is needed before MHR’s clinical utility can be established.