Abstract Background and purpose Early postoperative cerebral infarction (EPCI) remains a major complication following surgical treatment of aneurysmal subarachnoid hemorrhage (aSAH) and contributes to unfavorable neurological outcomes. The neutrophil-to-apolipoprotein A1 ratio (NAR), which indicates systemic inflammation and lipid-related vascular protection, has shown prognostic significance in multiple vascular diseases. However, its clinical value in identifying patients at risk of EPCI after aSAH remains unclear. Methods This retrospective study included 517 patients with aSAH who underwent surgical treatment. Patients were divided into four groups according to the quartiles of their admission NAR. The relationship between NAR and EPCI was investigated using multivariable logistic regression, receiver operating characteristic curve analysis, restricted cubic spline modeling, subgroup analyses, and propensity score matching. Results Of the 517 patients included, 90 (17.41%) developed EPCI. Higher NAR levels were associated with increased clinical and radiological severity, including higher Hunt–Hess and modified Fisher grades, as well as a significantly increased risk of EPCI. NAR was independently linked to EPCI after controlling for confounders (adjusted odds ratio = 1.16; 95% CI: 1.09–1.24; P < 0.001). aSAH patients in the highest quartile exhibited a 2.68-fold higher risk of EPCI compared to those in the lowest quartile. Receiver operating characteristic curve analysis indicated that NAR had moderate discriminative ability for EPCI, with an area under the curve of 0.698. Restricted cubic spline analysis demonstrated a positive dose-response association. These findings were consistent across subgroup analyses and were further corroborated by propensity score matching. Conclusions Higher admission NAR independently correlated with an increased risk of post-operative EPCI and unfavourable prognosis. NAR, as an affordable and readily accessible biomarker, could offer practical benefits for early risk assessment and perioperative clinical management.
Shangguan et al. (Thu,) studied this question.