C-Reactive Protein-to-Albumin Ratio as a Predictor of Short-Term Functional Outcomes After Spontaneous Intracerebral...

Background The C-reactive protein-to-albumin ratio (CAR) is an emerging biomarker reflecting systemic inflammation and nutritional status. However, evidence regarding its prognostic value for short-term functional outcomes after spontaneous intracerebral hemorrhage (ICH), particularly in resource-limited settings, remains limited. This study aimed to investigate the associations between the early CAR and 30-day functional outcomes in patients with spontaneous ICH. Methods This prospective cohort study enrolled 250 adults with first-ever CT-confirmed spontaneous ICH and admission National Institutes of Health Stroke Scale (NIHSS) scores of 5-15 at two tertiary hospitals in Dhaka, Bangladesh, between February 2021 and January 2023. Of these, 220 patients with available 30-day outcome data were included in the complete-case analysis. Clinical, laboratory, and radiological data were collected, and the CAR was calculated from samples obtained during the initial laboratory evaluation after hospital presentation and within 72 hours of stroke onset. The primary outcome was 30-day functional status assessed using the modified Rankin scale (mRS), categorized as favorable (0-3) or unfavorable (4-6). Multivariable logistic regression identified independent predictors of unfavorable outcomes, and receiver operating characteristic analysis evaluated the discriminatory performance of CAR. Results Among the 220 patients, 130 (59.1%) experienced an unfavorable outcome. The CAR was moderately correlated with the mRS score (rs = 0.513, p < 0.001). According to the multivariate analysis, a higher CAR independently predicted unfavorable outcomes (adjusted OR 4.51; 95% CI 1.63-12.50; p = 0.004). Additional predictors included increasing age, hemiparesis, aspiration pneumonia, hypernatremia, and elevated serum creatinine. ROC analysis revealed good discriminative ability of the CAR, with an area under the curve of 0.841; a cutoff value of 0.44 yielded 78.1% sensitivity and 87.1% specificity. Conclusions Within this selected cohort of patients with NIHSS scores of 5-15, a higher early CAR was independently associated with unfavorable 30-day functional outcomes after spontaneous ICH. The identified cutoff should be considered cohort-specific and requires validation in unselected ICH populations across the full severity spectrum with 90-day follow-up.