AUTHOR=Feng Yuning , Cui Wenyao , Xiao Yangchun , Cheng Xin , Chen Lvlin , Peng Liyuan , You Chao , Fang Fang , Li Li , Lu Dianxiang , Zhang Yu 

TITLE=Elevated neutrophil to high-density lipoprotein ratio predicts pneumonia in patients with intracerebral hemorrhage

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1572131

DOI=10.3389/fmed.2025.1572131

ISSN=2296-858X

ABSTRACT=BackgroundPneumonia is a common and serious complication among patients with intracerebral hemorrhage (ICH), contributing to increased morbidity and mortality. Early identification of patients at high risk for pneumonia is essential for implementing preventive strategies and improving outcomes. The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) has emerged as a novel marker of systemic inflammation with potential predictive value. This study examines whether elevated NHR is associated with an increased risk of pneumonia in patients with ICH, aiming to evaluate NHR as a practical biomarker for early risk prediction.MethodsThis retrospective multicenter cohort study included patients diagnosed with intracerebral hemorrhage (ICH) from three hospitals: West China Hospital of Sichuan University (December 2010 to August 2019), The First People’s Hospital of Longquanyi District, Chengdu (December 2016 to November 2020), and the Affiliated Hospital of Chengdu University (August 2012 to November 2020). Patients were stratified into two groups based on their NHR: less than 6.84 and 6.84 or greater. The primary outcome was the occurrence of pneumonia during hospitalization.ResultsAmong the 2,639 patients, the incidence of pneumonia was 27.5% (363 of 1,320) in the low NHR group (NHR < 6.84) and 47.4% (625 of 1,319) in the high NHR group (NHR ≥ 6.84). Unadjusted models showed that patients in the high NHR group had a significantly increased risk of developing pneumonia compared to those in the low NHR group (odds ratio [OR], 2.37; 95% confidence interval [CI], 2.02–2.79; p < 0.001). After adjusting for confounding factors, this association remained significant (adjusted OR, 2.64; 95% CI, 1.37–5.07; p = 0.004). Furthermore, when analyzing NHR as a continuous variable, each unit increase in NHR was associated with an increased risk of pneumonia (adjusted OR, 1.03; 95% CI, 1.01–1.04; p < 0.001).ConclusionElevated NHR was significantly associated with an increased risk of pneumonia among patients with intracerebral hemorrhage. Given its simplicity and potential diagnostic value, NHR may serve as a useful biomarker for predicting pneumonia risk in this population, facilitating early identification and potentially improving patient outcomes.