Prognostic value of admission NHHR for functional recovery in acute ischemic stroke

Background: Early risk stratification in acute ischemic stroke (AIS) is critical for guiding management and improving outcomes. The ratio of non-high-density lipoprotein to high-density lipoprotein cholesterol (NHHR) represents the equilibrium between pro-atherogenic and anti-atherogenic lipoproteins, potentially capturing both lipid metabolism and inflammatory status, but its prognostic value in AIS remains unclear. Methods: We retrospectively analyzed 812 first-ever AIS patients. Admission NHHR was calculated from routine lipid panels. The study's main outcome was 90-day functional status, determined using the modified Rankin Scale. Associations with NHHR were examined through multivariable logistic regression, quartile analyses, restricted cubic spline (RCS) modeling, and subgroup analyses. Results: Among 812 patients, 255 (31.4%) had unfavorable outcomes. Elevated NHHR showed an independent correlation with unfavorable 90-day functional outcomes (adjusted OR per unit increase, 1.233; 95% CI, 1.058-1.439; P = 0.0076). RCS analysis demonstrated a gradual rise in risk with increasing NHHR (P for trend = 0.043; P for nonlinearity = 0.584). Subgroup analyses showed consistent associations across sex, stroke severity, smoking, drinking, hypertension, and diabetes. Conclusion: Admission NHHR is a simple, inexpensive, and robust predictor of 90-day unfavorable outcomes in AIS. It provides a novel integrated lipid-inflammation marker for early risk stratification, warranting further validation in prospective studies.