Serum lipid levels predict mortality of aged patients in acute intracerebral hemorrhage

Background Intracerebral hemorrhage (ICH) carries high early mortality. Admission lipids have been linked to short-term outcomes, yet prior studies focused on conventional markers and rarely assessed age-specific effects. Because older adults often have lower nutritional reserve and higher medical complication rates, the prognostic value of lipids may be age dependent. We therefore evaluated a broader lipid profile to test their associations with 90-day mortality across different age group. Methods We conducted a single-center cohort at a tertiary academic hospital. Serum lipids, including total cholesterol(TC), triglycerides(TG), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C), apolipoprotein A1(Apo A1), and apolipoprotein B(Apo B), were measured upon hospital admission. Patients were stratified as < 45 years and ≥ 45 years. Multivariate logistic regression was applied to investigate the associations between lipid levels, lipid ratios, and 90-day mortality. Discrimination was assessed using stratified 5-fold cross-validated single-marker receiver operating characteristic (ROC) analyses. Results We included 503 patients with acute ICH. In those older than 45 years, lower nonHDL-C (OR 0.898; 95%CI 0.814–0.990), Apo B (OR 0.861; 95%CI 0.748–0.990), nonHDL-C/HDL-C (OR 0.964; 95%CI 0.930–0.999), and Apo B/Apo A1 (OR 0.816; 95%CI 0.687–0.968) were independently associated with higher 90-day mortality. In ROC analyses, Apo B (AUC = 0.671) and Apo B/Apo A1 (AUC = 0.676) showed the highest discrimination among single markers, indicating modest predictive performance. Conclusion Lipid levels and ratios, particularly Apo B and Apo B/Apo A1, are independent predictors of 90-day mortality in middle-aged and older ICH patients, aiding clinical risk stratification.