# HDL-related lipid ratios reflecting metabolic inflammation are associated with endometriosis status and ASRM stage

## TL;DR

This study finds that certain HDL-related lipid ratios are linked to endometriosis presence and severity, suggesting their potential use in clinical assessments.

## Contribution

The study is the first to demonstrate the association between HDL-related lipid ratios and both endometriosis status and ASRM staging.

## Key findings

- LHR was inversely associated with endometriosis status, while MHR, NHR, and NHHR were positively associated.
- All four lipid ratios were significantly associated with advanced ASRM stage compared to early-stage disease.
- MHR and NHR showed the highest discriminative performance for ASRM stage and endometriosis status classification.

## Abstract

Inflammation is central to the pathogenesis of endometriosis. High-density lipoprotein (HDL)-related lipid ratios have been proposed as indicators of systemic metabolic inflammation, yet their associations with endometriosis status and ASRM stage remain unclear.

A total of 5,161 women were included, comprising 113 surgically confirmed endometriosis patients and 5,048 women without endometriosis. Multivariable logistic regression was used to evaluate the associations between four HDL-related lipid ratios—lymphocyte-to-HDL ratio (LHR), monocyte-to-HDL ratio (MHR), neutrophil-to-HDL ratio (NHR), and non-HDL-to-HDL ratio (NHHR)—and endometriosis status, with propensity score matching (PSM) applied to assess robustness. Among women with endometriosis, analyses were restricted to 105 patients with complete revised American Society for Reproductive Medicine (ASRM) staging data. Multivariable logistic regression was used to examine the associations between HDL-related lipid ratios and ASRM stage (early vs. advanced), with inverse probability of treatment weighting (IPTW) applied for robustness assessment. Receiver operating characteristic (ROC) curves were constructed to evaluate discriminative performance.

LHR was inversely associated with endometriosis status (OR = 0.52, 95% CI: 0.30–0.90), whereas MHR (OR = 3.30, 95% CI: 2.02–5.39), NHR (OR = 4.32, 95% CI: 2.77–6.78), and NHHR (OR = 2.14, 95% CI: 1.20–3.78) were positively associated. All four HDL-related lipid ratios were significantly associated with advanced ASRM stage relative to early-stage disease, including LHR (OR = 3.97, 95% CI: 1.14–15.7), MHR (OR = 6.60, 95% CI: 1.96–26.8), NHR (OR = 4.65, 95% CI: 1.50–16.8), and NHHR (OR = 8.03, 95% CI: 1.47–54.3). PSM and IPTW confirmed the robustness of these associations. ROC results showed that MHR had the highest AUC for ASRM stage classification (0.763), whereas NHR had the highest AUC for endometriosis status classification (0.715).

HDL-related lipid ratios are significantly associated with endometriosis status and ASRM stage. These findings suggest the potential utility of HDL-related lipid ratios as adjunctive indicators for clinical stratification.