Association of platelet to HDL-C ratio with short-term mortality in critically ill intracerebral hemorrhage patients: a MIMIC-IV analysis

Intracerebral hemorrhage (ICH) is associated with substantial early mortality, yet prognostic biomarkers integrating coagulation, inflammation, and lipid metabolism are limited. The platelet to high-density lipoprotein cholesterol ratio (PHR) may reflect this balance. In a retrospective cohort of 878 critically ill ICH patients from the MIMIC-IV database (mean age 69.6 ± 13.8 years, 55.0% female), overall in-hospital and 30-day mortality were 15.0% and 20.5%, respectively. Short-term mortality was defined as death occurring either during hospitalization (in-hospital mortality) or within 30 days of admission (30-day mortality). Higher PHR at ICU admission was independently associated with lower short-term mortality. Each 1-SD increase corresponded to a 20–28% reduction in risk for in-hospital (adjusted HR 0.72, 95% CI 0.59–0.87) and 30-day mortality (HR 0.80, 95% CI 0.68–0.94). When analyzed by quartiles, patients in the highest PHR group had the lowest mortality (in-hospital HR 0.49, 95% CI 0.29–0.83; 30-day HR 0.55, 95% CI 0.35–0.88), consistent with Kaplan-Meier survival analyses. Restricted cubic spline analysis indicated a linear inverse relationship. Results were robust in subgroup analyses and largely consistent in sensitivity analyses, with modest attenuation for in-hospital mortality. These findings suggest PHR has an independent inverse relationship with short-term mortality. Important prognostic factors, including hematoma volume and location, were unavailable; PHR may reflect underlying disease severity rather than causal protection. Intracerebral hemorrhage (ICH) is associated with substantial early mortality, yet prognostic biomarkers integrating coagulation, inflammation, and lipid metabolism are limited. The platelet to high-density lipoprotein cholesterol ratio (PHR) may ref... [2219 chars]