Objective: To investigate the predictive value of neutrophil to lymphocyte ratio (NLR) combined with hematoma imaging features for delayed perihematoma edema (dPHE) after spontaneous basal ganglia hemorrhage.

Methods: Retrospective inclusion of patients with spontaneous basal ganglia hemorrhage admitted to the neurology department of Jinhua Hospital affiliated to Zhejiang University School of Medicine (Jinhua Municipal Central Hospital) from January 2017 to December 2023. We compared clinical data between the dPHE group and no-dPHE group based on the univariate analysis and multivariate binary logistic regression analysis. We identified the independent influencing factors of dPHE, and evaluated the predictive value of the model for dPHE using receiver operating characteristic (ROC).

Results: A total of 372 patients were included in this study, including 115 in the dPHE group and 257 in the no-dPHE group. Univariate analysis showed that the baseline National Institutes of Health Stroke Scale (NIHSS) score, baseline hematoma volume, high-sensitivity Creactive protein, lymphocyte count, NLR, blend sign, lateral hematoma, and high-dose mannitol proportion in the dPHE group were significantly higher than those in the non-dPHE group (P<0.05). Moreover, the NIHSS score and hospitalization expenses in the dPHE group were higher than those in the no-dPHE group (P<0.05), and their hospitalization time was also longer in the dPHE group (P<0.05). Furthermore, the multivariate logistic regression analysis revealed that NLR [odds ratio (OR) ＝1.138 (95% CI: 1.056-1.227); P＝0.001], baseline hematoma volume [OR＝1.187 (95% CI: 1.132-1.246); P<0.001] and lateral hematoma [OR＝3.067 (95% CI: 1.611-5.838); P＝0.001] were independent predictive factors of dPHE. ROC analysis showed that the area under the curve of the model was 0.810 (95% CI: 0.765-0.856).

Conclusion: The higher the baseline NLR, the larger the hematoma volume, and patients with lateral basal ganglia hemorrhage are more susceptible to dPHE.