Association of the apolipoprotein B/apolipoprotein A1 ratio with 90-day mortality after acute intracerebral hemorrhage: a single-center cohort study

Background and purpose Previous studies have linked lipid measures to hematoma expansion and outcomes after intracerebral hemorrhage (ICH), but prognostic evidence for the apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio remains limited. We examined the associations of acute-phase ApoB/ApoA1 with 90-day mortality and poor functional outcome after primary ICH and evaluated its incremental prognostic information beyond the ICH score. Methods We conducted a single-center observational cohort study of adults with primary ICH who underwent baseline CT within 72 h after symptom onset. The primary outcome was 90-day all-cause mortality; the secondary outcome was poor functional outcome at 90 days. Logistic regression examined associations of ApoB/ApoA1 with outcomes in unadjusted and ICH score-adjusted models. Incremental value beyond the ICH score was assessed using discrimination, Brier score, calibration, and bootstrap internal validation. Results Among 470 included patients, 73 (15.5%) died and 190 (40.4%) had poor functional outcome at 90 days. Higher ApoB/ApoA1 was associated with lower 90-day mortality after adjustment for the ICH score (OR per 0.1-unit increase, 0.82; 95% CI, 0.71–0.96; p = 0.012), but not with poor functional outcome (OR, 0.97; 95% CI, 0.90–1.06; p = 0.531). Adding ApoB/ApoA1 to the ICH score yielded a limited increase in discrimination for 90-day mortality (ΔAUC, 0.027; bootstrap 95% CI, 0.008–0.057; likelihood-ratio p = 0.008), with little change in Brier score or calibration. No meaningful improvement was observed for poor functional outcome. Conclusion Higher acute-phase ApoB/ApoA1 was associated with lower 90-day mortality, but not poor functional outcome, after accounting for the ICH score. ApoB/ApoA1 provided limited incremental prognostic information for 90-day mortality beyond the ICH score. Clinical usefulness remains uncertain, and external validation is needed.