Neutrophil Percentage-to-Albumin Ratio is Associated with Functional Outcome, Hematoma Clearance, and Peak Perihematomal Edema in Supratentorial Intracerebral Hemorrhage

Purpose: Although inflammatory markers have been implicated in the prognosis of intracerebral hemorrhage (ICH), their associations with peak perihematomal edema (PHE) and hematoma clearance remain unclear. This study evaluated inflammatory markers, focusing on the neutrophil percentage-to-albumin ratio (NPAR), to determine their prognostic relevance in supratentorial ICH. Patients and Methods: We retrospectively analyzed patients with supratentorial ICH who arrived at Beijing Tiantan Hospital within 24h of symptom onset between January 2021 and December 2022. Both inflammatory and imaging markers were measured at multiple time points. Hematoma and PHE volumes were quantified using 3D Slicer software. The primary outcome was 90-day functional outcome assessed with the modified Rankin Scale (mRS). LASSO regression was used to identify inflammation-related indices most strongly associated with 90-day functional outcome. Multivariable logistic and linear regression analyses were then performed to examine associations between inflammatory markers, 90-day outcomes, peak PHE, and the maximum hematoma clearance percentage (MHCP). Results: A total of 470 patients were included. LASSO regression identified NPAR as the strongest inflammation-related predictor of 90-day outcome. Higher admission NPAR independently related with greater peak PHE (r = 0.15, P = 0.001), and poor functional outcome (adjusted OR 1.15, 95% CI 1.03– 1.30), with a 2.52-fold increased risk in the highest quartile versus lowest quartile. Elevated NPAR levels at 1– 3, 4– 7, and > 7 days after admission remained associated with poor outcome (all p < 0.05). Admission NPAR was also associated with MHCP (adjusted OR 0.85, 95% CI 0.75– 0.97). Restricted cubic spline analysis revealed a nonlinear relationship, with optimal clearance observed at moderate NPAR levels. Conclusion: NPAR was independently associated with poor functional outcome and greater peak PHE, while also being associated with hematoma clearance dynamics, highlighting the complex relationship between systemic inflammation, host reserve, and recovery processes in supratentorial ICH.