Serum Albumin-Globulin Ratio and Rupture Status of Intracranial Aneurysms: A Case-Control Study

Identifying biomarkers associated with intracranial aneurysm (IA) rupture status is critical for clinical management. This study investigated the association between serum albumin-to-globulin ratio (AGR) and IA rupture status.

We conducted a case-control study including 545 patients with unruptured intracranial aneurysms (uIAs) and 404 patients with ruptured intracranial aneurysms (rIAs). Propensity score matching (PSM) was further performed based on five key variables: age, sex, hypertension status, aneurysm location, and size, yielding 235 pairs. Associations between serum AGR and IA rupture status were evaluated using both unconditional and conditional multivariate logistic regression models. We assessed the incremental model performance of AGR beyond conventional clinical variables for aneurysm rupture status using net reclassification improvement, integrated discrimination improvement, likelihood ratio test, and calibration test.

After adjustment for confounding factors, patients in the highest AGR quartile had 52% lower odds of presenting with a ruptured intracranial aneurysm than those in the lowest quartile (OR: 0.48, 95% CI: 0.28-0.80; P for trend = 0.01). In the propensity score-matched pairs, the highest AGR tertile was independently associated with lower odds of presenting with a ruptured intracranial aneurysm than the lowest tertile (OR: 0.42, 95% CI: 0.21-0.81; P for trend = 0.01). Furthermore, the addition of AGR improved model fit, calibration, and reclassification in both the unmatched and matched analyses.

Serum AGR was associated with rupture status in patients with intracranial aneurysms. Prospective studies are warranted to further clarify the temporal relationship of this association and to explore potential underlying mechanisms.