Association Between Admission Serum Glucose–Phosphate Ratio and In‐Hospital Mortality in Critically Ill Patients With Intracranial Hemorrhage: A Retrospective Cohort Study

Objective: Early identification of spontaneous intracranial hemorrhage (ICH) patients at high risk of mortality is of great importance. This study aimed to investigate the association between admission serum glucose–phosphate ratio (GPR) and in‐hospital mortality in critically ill ICH patients. Methods: Data were obtained from the Medical Information Mart for Intensive Care (MIMIC) IV database. Patients were grouped by tertiles of GPR. The primary outcome was in‐hospital mortality. Multivariable Cox regression analysis, restricted cubic spline curves, subgroup analysis, and sensitivity analysis were conducted to assess the GPR‐mortality association. Results: A total of 1711 patients were included in this study. The overall in‐hospital mortality rate was 19.2% (328/1711). A linear relationship was observed between GPR and in‐hospital mortality. After adjusting for potential confounders, each unit increase in GPR was independently associated with a 1% increase in mortality risk (adjusted HR 1.01, 95% CI 1.00–1.02; p = 0.003). This elevated risk exhibited logarithmic decay over time (interaction term HR = 1.00, 95% CI: 0.99–1.00, p = 0.049). Compared to the lower GPR tertile, patients in the middle and upper tertiles showed 53% (adjusted HR 1.53, 95% CI 1.13–2.09) and 60% (adjusted HR 1.60, 95% CI 1.18–2.18) increased mortality risks, respectively. Subgroup and sensitivity analyses confirmed the stability of the results. Conclusion: In critically ill patients with ICH, elevated admission GPR demonstrated a significant association with increased in‐hospital mortality, suggesting its potential utility as a prognostic biomarker for early risk stratification in this population.