A novel inflammatory score predicts hematoma expansion and 90‑day functional outcomes after spontaneous intracerebral hemorrhage

BACKGROUND: Intracerebral Hemorrhage (ICH) entails high morbidity and rapid clinical deterioration; early risk stratification is critical. Although inflammatory biomarkers correlate with Hematoma Expansion (HE) and outcomes, their incremental value over existing models is uncertain. METHODS: The authors retrospectively included consecutive acute ICH admissions to Tongji Hospital (2012‒2024). An inflammatory score (0‒9) was derived from the first post-admission blood draw (on admission or next morning), all within 24 h of admission, using neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index (neutrophil × platelet/lymphocyte), lactate dehydrogenase, and high-sensitivity C-reactive protein. HE was defined as > 6 mL or > 33% on 24‒48 h follow-up Computed Tomography (CT). 90-day outcomes were poor function (modified Rankin Scale mRS score 4‒6) and mortality. Multivariable models used multiple imputation. RESULTS: HE analyses included 1047 patients with baseline and 24‒48 h follow-up CT; 298 (28.5%) had HE. Outcome analyses included 953 patients (94-lacked 90-day follow-up); 399 (41.9%) had mRS 4‒6 and 120 (12.6%) died. The score was independently associated with HE (adjusted Odds Ratio 1.18), poor function (1.27), and mortality (1.30). Adding the score increased the area under the receiver operating characteristic curve (AUC) for HE (0.681 to 0.709; ΔAUC = 0.029; p = 0.007), poor function (0.826 to 0.842; ΔAUC = 0.016; p = 0.014), and mortality (0.815 to 0.838; ΔAUC = 0.022; p = 0.036). Sensitivity analyses, including a ≤ 6 h landmark analysis, inverse probability weighting (IPW) for follow-up availability, and complete-case analyses, yielded similar effects. CONCLUSION: An admission laboratory-based inflammatory score provides independent, incremental prognostic value for HE and 90-day outcomes after ICH. REGISTRATION-URL: http://www.chictr.org.cn. Unique identifier: ChiCTR-ROC-2,000039365.