Comparative Associations of Three Nutritional Indices with Hematoma Expansion After Intracerebral Hemorrhage

Why It Matters

Identifying patients at high risk for hematoma expansion enables timely therapeutic decisions, and CONUT offers a simple, lab‑based tool to improve early stratification in intracerebral hemorrhage.

Key Takeaways

• CONUT score predicts hematoma expansion in ICH patients
• Higher CONUT linked to 29% increased HE odds per point
• PNI and TCBI showed no independent association
• Study of 349 patients, 12% experienced hematoma expansion
• CONUT combines albumin, lymphocytes, cholesterol for risk stratification

Pulse Analysis

Intracerebral hemorrhage remains one of the deadliest stroke subtypes, with hematoma expansion driving early neurological decline and mortality. Clinicians rely on imaging markers such as the CTA spot sign, but these require specialized equipment and may not be available in all settings. Consequently, there is growing interest in readily obtainable clinical variables that can flag patients at risk before significant growth occurs. Nutritional status, reflected by routine blood tests, emerges as a promising candidate because it captures systemic resilience that influences coagulation and vascular integrity.

The Controlling Nutritional Status (CONUT) score integrates serum albumin, total lymphocyte count, and total cholesterol—parameters that collectively represent protein reserves, immune competence, and lipid‑mediated membrane stability. In the examined cohort, each incremental CONUT point corresponded to a 29% rise in the odds of hematoma expansion, a relationship that persisted after adjusting for age, baseline hematoma volume, blood pressure, and other confounders. By contrast, the Prognostic Nutritional Index and the triglyceride‑cholesterol‑body weight index, which omit cholesterol or immune components, failed to predict expansion. This suggests that the triad of albumin, lymphocytes, and cholesterol uniquely mirrors the acute metabolic vulnerability that predisposes to ongoing bleeding.

For stroke units, incorporating CONUT into admission protocols could streamline risk assessment without additional cost or delay. Patients flagged by a high CONUT could receive intensified blood‑pressure control, early hemostatic therapy, or closer imaging surveillance. However, the single‑center, retrospective design limits generalizability, and prospective multicenter trials are needed to confirm utility and define optimal cut‑offs. Future research should also explore whether targeted nutritional interventions can modify CONUT scores and, ultimately, reduce hematoma expansion rates, thereby improving outcomes for this high‑risk population.