ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neurological Biomarkers
This article is part of the Research TopicStroke and Inflammation: From Risk Factors and Pathogenesis to Clinical Implications and Therapeutic StrategiesView all articles
Admission Monocyte-to-Albumin Ratio Predicts 3-Month Functional Outcomes after Acute Ischemic Stroke: A Retrospective Cohort Study
Provisionally accepted
- 1Quzhou City People's Hospital, Quzhou, China
- 2The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Background: The monocyte-to-albumin ratio (MAR) integrates inflammation and nutritional status from routine laboratory data. We assessed whether the admission MAR is associated with 3-month functional outcomes after acute ischemic stroke (AIS). Methods: We analyzed a single-center, retrospective cohort of consecutive adults with AIS admitted within 3 days of onset (October 2023–March 2024). MAR was calculated from the admission monocyte count and serum albumin level. The primary outcome was poor 3-month function, defined as the modified Rankin scale (mRS) ≥3. Associations were examined using multivariable logistic regression (with and without adjustment), smooth curve fitting, and prespecified subgroup analyses (sex, age, smoking status, drinking status, hypertension, diabetes status, eGFR, and TOAST subtype). Results: Among 395 patients (mean age 66.2 years; 34.7% female), 59 (14.9%) had poor outcomes. A higher admission MAR independently predicted poor outcomes: per 1-unit increase, the adjusted odds ratio (OR) was 1.13 (95% CI 1.07–1.20; P<0.001). Compared with the low tertile, the high tertile had significantly greater odds (OR 3.21; 95% CI 1.25–8.20) with a linear trend (P for trend=0.006). Smooth curve fitting indicated a largely monotonic increase in risk across the observed MAR range. Associations were consistent across subgroups with no significant interactions (all interactions P>0.05). With respect to the TOAST subtype, the MAR remained significant for large‑artery atherosclerosis (OR 1.10; 95% CI 1.02–1.20) and small‑artery occlusion (OR 1.23; 95% CI 1.07–1.42), but not cardioembolism. Conclusions: The admission MAR is independently and positively associated with poor 3‑month functional outcomes after AIS. MAR is a promising tool for early risk assessment when it is integrated with established predictors.
Keywords: Acute ischemic stroke, Monocyte‑to‑albumin ratio, Inflammation, prognosis, risk stratification
Received: 03 Oct 2025; Accepted: 21 Nov 2025.
Copyright: © 2025 Lu, Wang, Yang, Lin and Jiang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Weifeng Jiang, weifengjiang@wmu.edu.cn
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