Association of the apolipoprotein B/apolipoprotein A1 ratio with 90-day mortality after acute intracerebral hemorrhage: a single-center cohort study
- 1Department of Neurology, The First Affiliated Hospital of Chongqing Medical University
- 2Department of Radiology, Chongqing University Fuling Hospital
- 3Department of Neurology, University-Town Hospital of Chongqing Medical University
Abstract
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.
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BibTeX
@article{huang2026association,
title = {{Association of the apolipoprotein B/apolipoprotein A1 ratio with 90-day mortality after acute intracerebral hemorrhage: a single-center cohort study}},
author = {Jun-Meng Huang and Yong-Bo Ma and Shu-Qiang Zhang and Chao-Yi Huang and Rui Feng and You-Dong Wei and Wen-Song Yang},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1898784},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1898784/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of the apolipoprotein B/apolipoprotein A1 ratio with 90-day mortality after acute intracerebral hemorrhage: a single-center cohort study
AU - Jun-Meng Huang
AU - Yong-Bo Ma
AU - Shu-Qiang Zhang
AU - Chao-Yi Huang
AU - Rui Feng
AU - You-Dong Wei
AU - Wen-Song Yang
PY - 2026
DA - 2026/10/29
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1898784
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1898784/full
AB - 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.
SN - 1664-2295
ER -