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. 2025 Feb 4;24(1):36.
doi: 10.1186/s12944-025-02459-z.

Association between the low-density lipoprotein to high-density lipoprotein ratio and prognosis in critically ill intracerebral hemorrhage patients: a retrospective cohort study from the MIMIC-IV database

Yuchen Liu #  1 , Houxin Fu #  2 , Yue Wang  3 , Yi Zhong  1 , Rongting Zhang  1 , Jingxuan Sun  1 , Tianquan Yang  1 , Yong Han  1 , Yongjun Xiang  1 , Bin Yuan  1 , Ruxuan Zhou  1 , Min Chen  1 , Hangzhou Wang  4
Affiliations

Association between the low-density lipoprotein to high-density lipoprotein ratio and prognosis in critically ill intracerebral hemorrhage patients: a retrospective cohort study from the MIMIC-IV database

Yuchen Liu et al. Lipids Health Dis. .

Abstract

Background: The relationship between lipid profiles and intracranial hemorrhage (ICH) has garnered increasing attention. The ratio of low-density lipoprotein to high-density lipoprotein (LHR) is one of the key lipid profile indices. However, studies investigating the association between LHR and the prognosis of critically ill ICH patients remain limited.

Methods: Data for this study were obtained from the MIMIC-IV 3.1 database. Initially, the association between LHR and short-term outcomes in ICH patients, including ICU mortality, in-hospital mortality, and 28-day mortality, was analyzed using Cox regression in both continuous and categorical models. Additionally, restricted cubic spline (RCS), subgroup, and sensitivity analyses were conducted to further validate our findings.

Results: The study included 873 critically ill ICH patients, among whom 20.3% (177/873) succumbed within 28 days. Higher LHR was independently associated with lower short-term mortality in ICH patients (28-day mortality: HR = 0.82, 95% CI: 0.68 ~ 0.99, P = 0.039; In-hospital mortality: HR = 0.7, 95% CI: 0.55 ~ 0.89, P = 0.004; ICU mortality: HR = 0.66, 95% CI: 0.48 ~ 0.92, P = 0.015). The RCS revealed a linear relationship between LHR and short-term all-cause mortality. Subgroup analyses demonstrated consistent results. The optimal cutoff value for LHR was determined to be 1.21. Comparing the mortality risk between the low-LHR and high-LHR groups, the high-LHR group exhibited higher survival rates (28-day mortality, P = 0.0052; In-hospital mortality, P = 0.019; ICU mortality, P = 0.044). Furthermore, higher LHR was also correlated with lower disease severity scores (SAPS-II: r = -0.158, P < 0.001, OASIS: r = -0.117, P = 0.006).

Conclusion: LHR was negatively associated with short-term mortality in critically ill ICH patients. It may aid clinicians in identifying high-risk individuals and providing timely interventions.

Keywords: Intracerebral hemorrhage; Lipid metabolism; Low-density lipoprotein to high-density lipoprotein ratio (LHR); MIMIC-IV; Prognosis.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was performed according to the guidelines of the Helsinki Declaration. The use of the MIMIC-IV database was approved by the review committee of the Massachusetts Institute of Technology and Beth Israel Deaconess Medical Center. The data is publicly available (in the MIMIC-IV database), therefore, the ethical approval statement and the requirement for informed consent were waived for this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion of participants
Fig. 2
Fig. 2
The restricted cubic spline analysis for the nonlinear association between the LHR and short-term all-cause mortality (A) 28-day, (B) In-hospital, and (C) ICU
Fig. 3
Fig. 3
Subgroup analysis for the correlation between the LHR and 28-day all-cause mortality in patients with ICH
Fig. 4
Fig. 4
Kaplan–Meier survival analysis curves for all-cause mortality, the cohort was divided into two groups based on the threshold value (1.21) determined by the ROC curve. A 28-day, B In-hospital, and (C) ICU
Fig. 5
Fig. 5
The correlation of LHR and the disease severity scores of patients with ICH (A) SOFA, B SAPS-II, and (C) OASIS
See this image and copyright information in PMC

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