Tehran University of Medical Sciences Iranian Journal of Allergy, Asthma and Immunology 1735-1502 0 0 2026 09 13 1 10 Feng Zhan Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Xinyuan Sun Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Rongling Wu Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Beibei Jia Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Yan Wei Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Jiao Zhang Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China Hui Su Senior Department of Neurosurgery, the First Medical Center of PLA General Hospital, Beijing, China Yikun Sun Department of Neurosurgery, Ninth Medical Center, PLA General Hospital, Beijing, China 2026 03 19 2026 05 21 This study examined associations of intracranial pressure (ICP) dynamics and early serum immunometabolic and inflammation-resolving biomarkers with 90-day outcomes after spontaneous intracerebral hemorrhage (ICH). This single-center observational cohort included 138 patients who underwent clinically indicated ICP monitoring and serum biomarker sampling. Biomarkers were measured within 24 hours after admission, and ICP features were extracted during the first 24 hours after catheter insertion. Patients were classified as having good (modified Rankin Scale [mRS] 0–3; n=82) or poor (mRS 4–6; n=56) outcomes. Logistic regression identified factors associated with poor outcome, while model discrimination and internal stability were assessed using receiver operating characteristic analysis and bootstrap validation. Patients with poor outcomes had lower admission Glasgow Coma Scale (GCS) scores, larger hematomas, more frequent ventricular involvement, greater ICP burden, higher lactate and interleukin-6 levels, and lower Resolvin D1 (RvD1) and Maresin 1 levels. Admission GCS score (odds ratio [OR]=0.84; 95% confidence interval [CI], 0.74–0.96), peak ICP (OR=1.14; 95% CI, 1.05–1.24), lactate (OR=1.58; 95% CI, 1.12–2.21), and RvD1 (OR=0.97; 95% CI, 0.95–0.99) were independently associated with poor outcome. The combined model achieved an area under the curve of 0.91 (95% CI, 0.86–0.96), with a bootstrap-corrected value of 0.89. Greater ICP burden and an adverse immunometabolic and inflammation-resolving profile were associated with poor functional outcomes. External validation and calibration are required before clinical application. https://ijaai.tums.ac.ir/index.php/ijaai/article/view/4775 https://ijaai.tums.ac.ir/index.php/ijaai/article/download/4775/2422