Association between Creatinine-to-Albumin Ratio and Mortality in Intracerebral Hemorrhage: a Superior Predictive Indicator

Yuhong Guo¹Qiaoyu You²Peng Wang³Jun Wan²Sen Zhang²Shijie Fan²Yikang Ouyang²Xiang Yuan²Tiangui Li⁴Jorge Luis Cuyubamba Dominguez⁵Yu Zhang^2*

• ¹Department of Neurosurgery, Shanxi Provincial People’s Hospital, Taiyuan, Shanxi, China, Taiyuan, China
• ²Center for Evidence-Based Medical, Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China, Chengdu, China
• ³Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China, Chengdu, China
• ⁴Department of Neurosurgery, West China Longquan Hospital Sichuan University, Chengdu, China, Chengdu, China
• ⁵Institutes for Systems Genetics, West China Hospital, Sichuan University, Chengdu, China, Chengdu, China

Background: Intracerebral hemorrhage is a severe and devastating condition with a high mortality rate worldwide. While creatinine and albumin levels have been studied individually, the prognostic value of the creatinine-to-albumin ratio in predicting mortality in intracerebral hemorrhage patients remains underexplored. Methods: We performed a retrospective cohort study of intracerebral hemorrhage patients from West China Hospital of Sichuan University (December 2010-July 2019) and The First People’s Hospital of Longquanyi District, Chengdu (January 2017-October 2020). Serum biomarker data from blood samples were collected within 24 hours of admission. The primary outcome is mortality, while secondary outcomes include renal, infectious, and neurological complications. Results: A total of 3,521 primary intracerebral hemorrhage patients were included in this study. Based on the Youden Index, 0.30 is the optimal threshold for dichotomizing creatinine-to-albumin ratio. Multivariate analysis showed that patients in higher quartiles of the creatinine-to-albumin ratio had significantly higher in-hospital mortality risks compared to those in the lowest quartile (Q1, reference group) (Q2: aOR 2.38, 95% CI: 1.40-4.03; Q3: aOR 2.87, 95% CI: 1.70-4.84; Q4: aOR 6.11, 95% CI: 3.68-10.15). Similar associations were observed for 30-day, 180-day, and 1-year mortality. Restricted cubic splines further supported this positive dose-response relationship. Receiver operating characteristic analysis showed that the creatinine-to-albumin ratio outperformed the neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in prognostic performance, especially in predicting in-hospital mortality (AUC = 0.74). Additionally, the dynamic changes in creatinine-to-albumin ratio showed a significant increase in AUC over time (p<0.001 for trend). Conclusion: Creatinine-to-albumin ratio can serve as an independent and superior predictor of mortality and complications in intracerebral hemorrhage patients. Its prognostic ability could surpass that of commonly used indicators, and its dynamic changes may provide additional valuable insights for prediction. However, further prospective studies are required to confirm its clinical applicability.