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. 2025 May 21;48(1):433.
doi: 10.1007/s10143-025-03575-1.

Serum creatinine-to-albumin ratio predicts mortality in hemorrhagic stroke: a novel threshold for risk stratification

Shuwen Sun  1 , Xiaobin Fei  2 , Xin Huang  3 , Kai Gong  2
Affiliations

Serum creatinine-to-albumin ratio predicts mortality in hemorrhagic stroke: a novel threshold for risk stratification

Shuwen Sun et al. Neurosurg Rev. .

Abstract

Hemorrhagic stroke (HS) is a life-threatening condition with high mortality, particularly in intensive care unit (ICU) settings. The serum creatinine-to-albumin ratio (CAR) has emerged as a novel biomarker integrating renal dysfunction and systemic inflammation, but its prognostic value in HS remains underexplored. This retrospective cohort study analyzed data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We included 1,046 adult ICU patients with HS (intracerebral or subarachnoid hemorrhage) and stratified them by CAR quartiles. The primary outcome was 28-day all-cause mortality (ACM). Multivariable Cox regression models adjusted for age, Glasgow Coma Scale (GCS) score, and comorbidities were used to assess associations. Predictive performance was evaluated using receiver operating characteristic (ROC) curves and restricted cubic spline (RCS) analysis. The 28-day mortality increased significantly across CAR quartiles (Q1-Q4: 21.8%, 19.1%, 36.0%, and 40.8%, respectively; P for trend < 0.001). In the fully adjusted model (Model 3), patients in the highest CAR quartile (Q4) had a 2.30-fold higher mortality risk (95% CI: 1.58-3.35; P < 0.001) compared to Q1. CAR demonstrated significantly higher discriminative ability (AUC = 0.612, 95% CI: 0.574-0.650) compared to isolated creatinine (AUC = 0.568) or albumin (AUC = 0.371) measurements (P < 0.01). RCS analysis revealed a nonlinear relationship, with CAR > 0.25 marking a critical threshold for increased mortality risk. CAR is an independent predictor of 28-day mortality in critically ill patients with HS, outperforming traditional single biomarkers. Its clinical accessibility and robust prognostic performance suggest potential utility for early risk stratification and personalized treatment strategies in HS management.

Keywords: Creatinine-to-albumin ratio; Hemorrhagic stroke; MIMIC-IV; Mortality.

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Conflict of interest statement

Declarations. Ethics approval: This retrospective study utilized data from the MIMIC-IV database, which is a publicly available database containing de-identified health-related data. The establishment of the MIMIC-IV database was approved by the Institutional Review Boards (IRB) of the Massachusetts Institute of Technology (MIT) and BIDMC, and the requirement for individual patient consent was waived due to the retrospective and de-identified nature of the data. All methods were performed in accordance with the relevant guidelines and regulations. Access to the MIMIC-IV database was granted to the authors after completing the required training and signing a data use agreement (Certification Number: 65328820). Consent to participate: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial statement: Clinical trial number: not applicable. Declaration of generative AI in scientific writing: During the preparation of this work, we used Deepseek in order to improve the readability and language of the manuscript. After using this tool, we reviewed and edited the content as needed and take full responsibility for the content of the published article.

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References

    1. GBD 2019 Stroke Collaborators (2021) Global, regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 20:795–820. https://doi.org/10.1016/S1474-4422(21)00252-0
    1. Puy L, Parry-Jones AR, Sandset EC et al (2023) Intracerebral haemorrhage. Nat Rev Dis Primers 9:14. https://doi.org/10.1038/s41572-023-00424-7 - DOI - PubMed
    1. Kim JY, Bae HJ (2017) Spontaneous intracerebral hemorrhage: management. J Stroke 19:28–39. https://doi.org/10.5853/jos.2016.01935 - DOI - PubMed
    1. Shi P, Rui S, Meng Q (2025) Association between serum creatinine-to-albumin ratio and 28-day mortality in intensive care unit patients following cardiac surgery: analysis of mimic-iv data. BMC Cardiovasc Disord 25:100. https://doi.org/10.1186/s12872-025-04505-1 - DOI - PubMed - PMC
    1. Wang J, Li H, Luo H et al (2024) Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database. Front Immunol 15:1373371. https://doi.org/10.3389/fimmu.2024.1373371 - DOI - PubMed - PMC

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