Prognostic value of C-reactive protein to albumin ratio for in-hospital mortality in acute stroke patients

This study aimed to evaluate the prognostic significance of the C-reactive protein to albumin ratio (CAR) in predicting in-hospital mortality among patients presenting with acute stroke. A total of 483 adult patients (≥ 18 years) consecutively hospitalized for stroke over a one-year period (July 2022 – July 2023) were analyzed retrospectively. Exclusion criteria include malignancy, autoimmune/rheumatological disorders, chronic infections, conditions affecting inflammation or protein status, including liver failure and nephrotic syndrome, cachexia (BMI < 18 kg/m²). Baseline demographics, comorbidities, and laboratory indices were recorded upon admission. The CAR was derived by dividing the C-reactive protein (CRP) level by the serum albumin level. Comparative analysis was conducted between the mortality and non-mortality groups. The independent prognostic value of CAR was determined via binary logistic regression model. Significant differences were observed between the mortality and non-mortality groups regarding baseline laboratory parameters. Patients in the in-hospital mortality group exhibited significantly higher levels of glucose ( p = 0.001), AST ( p = 0.001), white blood cell ( p = 0.001), CRP (< 0.001) and CAR (< 0.001) levels were found to be significantly higher. Conversely, hemoglobin levels were significantly lower in the mortality group ( p = 0.031). As a result of Binary logistic regression analysis to find independent predictors of in-hospital mortality CAR (Exp(B) 95% CI = 1.047 (1.026–1.068) p < 0.001) and glucose (Exp(B) 95% CI = 1.006 (1.000-1.011) p = 0.048) were found as independent predictors. ROC curve analysis demonstrated that a CAR cutoff value of 1.06 predicted in-hospital mortality with 74% sensitivity and 65% specificity AUC: 0.774, 95% CI: 0.686–0.862. The present study found a significant association between elevated CAR levels and early in-hospital mortality from all causes in patients with acute stroke. It also demonstrated that CAR may be an independent predictor of early in-hospital mortality from all causes in all patients hospitalized with acute stroke, both in the general ward and intensive care unit.