Admission low-density lipoprotein cholesterol and early haematoma expansion after spontaneous intracerebral haemorrhage

Background The association between low-density lipoprotein cholesterol (LDL-C) and haematoma expansion (HE) after spontaneous intracerebral haemorrhage (ICH) remains uncertain. This study evaluated whether admission LDL-C was independently associated with early HE and whether it improved prediction beyond the established clinical and imaging factors.Methods We retrospectively analysed 541 consecutive adult patients with acute spontaneous ICH who had admission lipid measurements and baseline and follow-up computed tomography. LDL-C was examined as a continuous variable, quartiles and prespecified clinical thresholds. Modified Poisson regression with robust variance was used to estimate relative risks (RRs). Dose-response, subgroup analyses, prediction-model evaluation and sensitivity analyses were performed. Prediction models were internally validated using stratified fivefold cross-validation repeated 100 times.Results Early HE occurred in 62 patients (11.5%). Median LDL-C was lower in patients with HE than in those without HE (2.17 vs. 2.45 mmol/L; p = 0.001). In the primary adjusted model, each 1 mmol/L lower LDL-C was associated with an increased HE risk (RR, 1.70; 95% CI, 1.33–2.19; p < 0.001). Patients in the lowest LDL-C quartile had a higher HE risk than those in the highest quartile (RR, 4.28; 95% CI, 2.01–9.12). Restricted cubic splines suggested an inverse, approximately linear association. Adding LDL-C provided limited incremental predictive value and did not consistently improve decision-curve net benefit.Conclusions Lower admission LDL-C was independently associated with early HE after spontaneous ICH. However, its incremental predictive value beyond clinical and imaging factors was limited. Independent replication and external validation are required before clinical application.