Association of Serum Albumin and the ApoB/ApoA1 Ratio with Acute Post-Stroke Cognitive Impairment: A Propensity Score–Matched Case–Control Study

Background and Purpose: Evidence regarding the associations of serum albumin and apolipoprotein-related markers with acute cognitive impairment (CI) after stroke remains limited. This study investigated the associations of serum albumin and the apolipoprotein B/apolipoprotein A1 ratio (ApoB/ApoA1) with acute CI assessed within 7 days after first-ever ischemic stroke (IS). Methods: This retrospective single-center case-control study included patients with first-ever IS who completed the Chinese version of the Mini-Mental State Examination (MMSE) within 7 days after stroke onset. Patients with an MMSE score of ≤ 25 were classified into the CI group, and those with an MMSE score of > 25 into the non-CI group. Propensity score matching was performed in a 1:1 ratio (caliper = 0.07; without replacement) based on age, sex, and education level. Associations were evaluated using logistic regression analyses. Results: Among 371 eligible patients, 175 were in the CI group and 196 were in the non-CI group. After matching, 144 pairs were included. In the matched cohort, albumin, ApoB, and ApoB/ApoA1 were lower in the CI group. In multivariable analysis, higher albumin (adjusted odds ratio 0.934, 95% confidence interval 0.887– 0.983; P=0.009) and higher ApoB/ApoA1 (adjusted odds ratio 0.429, 95% confidence interval 0.200– 0.919; P=0.030) were independently associated with lower odds of acute CI after stroke. The lowest odds of acute CI were observed at albumin levels of 39.300– 41.400 g/L and an ApoB/ApoA1 ratio of ≥ 0.883. Conclusion: In patients with first-ever IS, higher serum albumin levels and a higher ApoB/ApoA1 ratio were associated with lower odds of acute CI within 7 days after stroke. Multicenter prospective studies are needed to validate these findings and clarify the underlying mechanisms.