Abstract
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.
Data availability
The data that support the findings of this study are available from the corresponding author upon reasonable request.
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Acknowledgements
The authors extend their sincere appreciation to the Laboratory for Computational Physiology at the Massachusetts Institute of Technology (LCP-MIT) for maintaining access to the MIMIC-IV database. We also express our gratitude to Dr. Qilin Yang (The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China) , Jianmin Qu (the First People’s Hospital of Tongxiang, Zhejiang, China), and Dr. Jie Liu (Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, China) for their valuable assistance in the preparation of this manuscript.
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All authors contributed to the study conception and design. Methodology was developed by HYT and CQY. Software support was provided by CQY. Formal analysis and data management were handled by HYT and CQY. The first draft of the manuscript was written by HYT, CQY and ZQS, and all authors contributed to writing, review, and editing. Visualization was prepared by ZQS, and supervision was provided by CQY. All authors contributed significantly to and agree with the content of the manuscript.
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The research involving human participants was reviewed and approved by the Institutional Review Board of the Massachusetts Institute of Technology and the Beth Israel Deaconess Medical Center. In accordance with national legislation and institutional requirements, written informed consent from the participants was not required for this study.
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He, Y., Zhao, Q. & Cai, Q. Association of platelet to HDL-C ratio with short-term mortality in critically ill intracerebral hemorrhage patients: a MIMIC-IV analysis. Sci Rep (2026). https://doi.org/10.1038/s41598-026-43526-4
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DOI: https://doi.org/10.1038/s41598-026-43526-4
