Association of dynamic changes of hemoglobin-to-red blood cell distribution width ratio with all-cause mortality in patients with intracerebral hemorrhage

This study aimed to evaluate the time-dependent prognostic value of HRR for all-cause mortality in ICH patients. We included 2,447 ICH patients from the MIMIC-IV 3.1 database. Cox regression assessed HRR-mortality associations, while restricted cubic spline model evaluated non-linear relationships. Serial HRR trends were analyzed using temporal Pearson correlation analyses and ROC curves, with the optimal cutoff identified via surv_cutpoint. Results demonstrated a dynamic inverse association with all-cause mortality in ICH patients, with higher baseline HRR independently linked to an 88.5% reduced mortality risk. Both survivors and non-survivors exhibited progressive HRR declines during hospitalization, though non-survivors showed a steeper 14-day trajectory (0.835 to 0.553 vs. 0.919 to 0.710 in survivors, P < 0.001 for trend) and a daily decrease rate of -0.014 (r = -0.971). Consistent HRR declines across all subgroups. Daily HRR levels inversely correlated with mortality risk throughout hospitalization (adjusted HRs <1.0 at all time points, P < 0.05), with discharge HRR achieving peak discriminative accuracy (AUC = 0.763). A baseline HRR cutoff ≤0.74 identified high-risk patients with 25.14% mortality. HRR may serve as a dynamic prognostic indicator for ICH mortality risk stratification.