Albumin–globulin ratio predicts 90-day functional outcomes in anterior choroidal artery territory infarction: A two-center retrospective cohort study

This study investigates the association between baseline albumin-to-globulin ratio (AGR) and 90-day functional outcomes in patients with anterior choroidal artery (AChA) territory infarction. This two-center retrospective cohort study consecutively enrolled 201 patients with AChA territory infarction admitted between September 2018 and September 2024. The primary endpoint was poor functional outcome at 90 days, defined as a modified Rankin Scale score of 3 to 6. Multivariable logistic regression models were employed to assess the association between AGR and functional outcomes, with restricted cubic spline regression used to explore potential nonlinear relationships. Among 201 patients, 72 (35.8%) experienced poor functional outcomes at 90 days. Patients with poor outcomes had significantly lower AGR levels compared to those with favorable outcomes ( P < .001). In the fully adjusted model, each 0.1-unit increase in AGR was associated with a 21% reduction in the risk of poor functional outcome (odds ratio = 0.79, 95% confidence interval: 0.64–0.95, P = .015). Quartile analysis revealed a clear dose–response relationship, with the highest quartile showing an 86% reduction in the risk of poor outcome compared to the lowest quartile (odds ratio = 0.14, 95% confidence interval: 0.03–0.54, P = .007). The predictive performance of AGR (area under the curve [AUC] = 0.70) was superior to that of albumin (AUC = 0.58) or globulin (AUC = 0.67) alone. Restricted cubic spline analysis demonstrated a nonlinear relationship, with a sharp increase in the risk of poor outcomes when AGR fell below 1.4 ( P -overall = .019, P -nonlinear = .045). Subgroup analyses confirmed the consistency of this association across different clinical characteristics. Lower baseline AGR is independently associated with poor 90-day functional outcomes in patients with AChA territory infarction. An AGR threshold of 1.4 may serve as a potential cutoff for clinical risk stratification. AGR represents a readily available and valuable biomarker for early risk assessment and individualized management in this specific stroke subtype.