To investigate the relationship of serum vascular endothelial cadherin (VE-cadherin) and sphingosine-1-phosphate (S1P) levels with coagulation function and short-term prognosis in patients with hypertensive intracerebral hemorrhage (HICH).

A total of 134 HICH patients admitted to Handan Central Hospital from January 2022 to September 2024 were prospectively enrolled as the study group, and 134 healthy volunteers from the same period were enrolled as the control group in a 1∶1 ratio. The independent-samples t-test or Mann-Whitney U-test was used to compare serum levels of VE-cadherin, S1P, and coagulation function [including D-dimer (D-D), fibrinogen (FIB), prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (APTT)] between the two groups. HICH patients were divided into the mild deficit group (≤ 4, n=41), the moderate deficit group (5-15, n=33), the moderate-to-severe deficit group (16-20, n=35), and the severe deficit group (≥21, n=25) based on the National Institutes of Health stroke scale (NIHSS) score at admission (severity of illness). Pearson or Spearman correlation analysis was used to analyze the correlation between serum VE-cadherin and S1P levels and disease severity as well as coagulation function in HICH patients. Based on the modified Rankin scale (mRS) at 6-month follow-up, HICH patients were divided into the poor outcome group (mRS score ＞ 2 or death, n=60) and the good outcome group (mRS score ≤ 2, n=74). Univariate and multivariate Logistic regression analyses were used to identify factors influencing short-term prognosis in HICH patients, and receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of serum VE-cadherin and S1P levels for short-term prognosis. The area under the curve was compared using the DeLong test.

Compared with the control group (healthy volunteers), the treatment group (HICH patients) showed significantly higher serum levels of VE-cadherin [5.81 (4.55, 6.97) ng/mL vs 3.08 (2.77, 3.43) ng/mL, Z=-11.919, P＜0.001], D-D [0.67 (0.53, 0.85) mg/L vs 0.29 (0.23, 0.37) mg/L, Z=-13.495, P＜0.001], S1P [(287.43±39.42) ng/mL vs (210.06±28.01) ng/mL, t=18.519, P＜0.001], and FIB [(3.96±0.53) g/L vs (2.66±0.40) g/L, t=22.708, P＜0.001], as well as significantly prolonged TT [24.80 (22.95, 26.33) s vs 16.98 (15.16, 18.73) s, Z=-13.512, P＜0.001], PT [(15.58±3.44) s vs (12.00±0.97) s, t=11.638, P＜0.001], and APTT [(35.12±5.49) s vs (28.00±2.91) s, t=13.279, P＜0.001]. All differences were statistically significant. Serum levels of VE-cadherin, S1P, D-D, and FIB progressively increased, while PT, TT, and APTT progressively prolonged across the mild, moderate, moderate-to-severe, and severe deficit groups (all P＜0.05). Serum VE-cadherin and S1P levels in HICH patients were positively correlated with disease severity, D-D, FIB, PT, TT, and APTT (all P＜0.05). Multivariate Logistic regression analysis showed that increased hematoma volume, higher NIHSS score at admission, elevated VE-cadherin, and elevated S1P were independent risk factors for poor short-term prognosis in HICH patients (all P＜0.05), while a higher Glasgow coma score at admission was an independent protective factor (P＜0.05). The areas under the ROC curves for serum VE-cadherin, S1P levels, and their combination in predicting short-term prognosis in HICH patients were 0.824 (95%CI: 0.755-0.892), 0.815 (95%CI: 0.743-0.887) and 0.901 (95%CI: 0.851-0.952), with sensitivities of 55.0%, 73.3% and 91.7%, and specificities of 94.6%, 75.7% and 74.3%, respectively. The combined predictive efficacy was significantly better than that of serum VE-cadherin or S1P levels alone (Z=2.946, 3.061, P=0.003, 0.002).

Serum levels of VE-cadherin and S1P are elevated in HICH patients and are significantly associated with disease severity, coagulation dysfunction, and poor short-term prognosis. The combination of serum VE-cadherin and S1P levels has high predictive value for short-term prognosis.