Platelet-to-hemoglobin ratio: A novel biomarker for mortality risk in ACS

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Created On: 29/12/2025

Acute coronary syndrome, Diabetes mellitus

The platelet-to-hemoglobin ratio (PHR) is gaining attention as a potential biomarker in cardiovascular disease prognosis.

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Key take away

Higher platelet-to-hemoglobin ratio independently predicts increased long-term mortality in acute coronary syndrome, with stronger prognostic value among patients with diabetes mellitus.

Background

The platelet-to-hemoglobin ratio (PHR) is gaining attention as a potential biomarker in cardiovascular disease prognosis. However, its predictive value in acute coronary syndrome (ACS)—especially among individuals with diabetes mellitus (DM)—is not well-established. Hence, this retrospective cohort study evaluated the prognostic value of PHR in patients with DM and ACS.

Method

This study analyzed data from 843 ACS hospitalized patients. PHR values were calculated using routine admission complete blood count results. The main outcome was all-cause mortality, assessed over a median 25-month follow-up period. Statistical analyses included multivariate logistic regression, Cox proportional hazards modeling, receiver operating characteristic (ROC) curve evaluation, Kaplan–Meier survival analysis, and restricted cubic spline modeling, with additional subgroup comparisons based on diabetes status.

Result

Elevated PHR was found to be an independent risk factor for long-term mortality in the total study population (adjusted hazard ratio [aHR] 1.35). The connection was even more pronounced in patients with diabetes, illustrating a higher predictive value (aHR 1.52 in DM vs. 1.36 in non-DM).

ROC curve analysis further supported this enhanced predictive capability in the diabetic subgroup (area under the curve [AUC] 0.707 vs. 0.600). Kaplan–Meier curves exhibited substantially reduced survival among patients with high PHR levels, particularly those with diabetes. Restricted cubic spline modeling depicted a J-shaped pattern, indicating sharply increased mortality risk when PHR exceeded 2.2.

Conclusion

PHR is a strong, independent predictor of mortality in patients with ACS and demonstrates greater prognostic value in those living with DM. Given its low cost, simplicity, and accessibility through standard blood testing, PHR may serve as a beneficial tool for early risk stratification and clinical decision-making in ACS care.