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.