Serum creatinine-to-albumin ratio as a predictor of 28-day mortality in critically ill patients with ischemic stroke: A retrospective cohort study

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-06-28 DOI:10.1016/j.jocn.2025.111439

Shuwen Sun, Xin Huang, Xiaobin Fei, Kai Gong

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引用次数: 0

Abstract

The creatinine-to-albumin ratio (CAR) has emerged as a promising prognostic marker in critical illnesses, yet its role in ischemic stroke (IS) remains underexplored. This study aimed to evaluate the association between CAR and 28-day mortality in IS patients admitted to the intensive care unit (ICU). We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. A total of 1,596 IS patients admitted to the ICU between 2008 and 2019 were included. CAR was calculated as the ratio of serum creatinine to albumin levels at ICU admission, and patients were stratified into quartiles based on CAR values. The primary outcome was 28-day all-cause mortality. Multivariate Cox regression models, Kaplan-Meier survival analysis, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curves were used to assess the predictive value of CAR. Our results showed that higher CAR index was significantly associated with increased 28-day mortality. In multivariate Cox regression analysis, CAR remained an independent predictor of mortality after adjusting for age, gender, race, and comorbidities (HR: 1.33, 95 % CI: 1.12–1.59, p = 0.001). Patients in the highest CAR quartile (Q4) had a 2.76-fold increased risk of mortality compared to those in the lowest quartile (Q1) (HR: 2.76, 95 % CI: 1.93–3.94, p < 0.001). Subgroup analysis revealed that the association was stronger in patients without diabetes or renal disease. RCS analysis demonstrated a non-linear dose–response relationship, with a steeper increase in mortality risk at CAR levels above 0.288. CAR showed moderate predictive performance (AUC: 0.645, 95 % CI: 0.614–0.676), outperforming individual markers such as creatinine and albumin. CAR is an independent predictor of 28-day mortality in IS patients admitted to the ICU. By integrating renal dysfunction and systemic inflammation or malnutrition, CAR provides a comprehensive risk assessment, making it a valuable tool for risk stratification and clinical decision-making.

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血清肌酐与白蛋白比值作为缺血性脑卒中危重患者28天死亡率的预测指标：一项回顾性队列研究

肌酸酐与白蛋白比值（CAR）已成为危重疾病的一个有希望的预后指标，但其在缺血性卒中（IS）中的作用仍未得到充分探讨。本研究旨在评估CAR与入住重症监护病房（ICU）的IS患者28天死亡率之间的关系。我们使用重症医疗信息市场IV （MIMIC-IV）数据库的数据进行了一项回顾性队列研究。在2008年至2019年期间，共有1596名IS患者入住ICU。CAR计算为ICU入院时血清肌酐与白蛋白水平之比，并根据CAR值将患者分层为四分位数。主要终点为28天全因死亡率。采用多变量Cox回归模型、Kaplan-Meier生存分析、限制性三次样条（RCS）分析和受试者工作特征（ROC）曲线评估CAR的预测价值。我们的研究结果显示，较高的CAR指数与28天死亡率增加显著相关。在多变量Cox回归分析中，在调整了年龄、性别、种族和合并症后，CAR仍然是死亡率的独立预测因子（HR: 1.33, 95% CI: 1.12-1.59, p = 0.001）。CAR最高四分位数（Q4）的患者死亡风险比最低四分位数（Q1）的患者高2.76倍(HR: 2.76, 95% CI: 1.93-3.94, p <；0.001)。亚组分析显示，在没有糖尿病或肾脏疾病的患者中，这种相关性更强。RCS分析显示了非线性剂量-反应关系，CAR水平高于0.288时，死亡风险急剧增加。CAR表现出中等的预测性能（AUC: 0.645, 95% CI: 0.614-0.676），优于个体标志物，如肌酐和白蛋白。CAR是入住ICU的is患者28天死亡率的独立预测因子。通过整合肾功能障碍和全身性炎症或营养不良，CAR提供了全面的风险评估，使其成为风险分层和临床决策的宝贵工具。

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来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.