Serum creatinine-to-albumin ratio as a prognostic marker for short- and long-term mortality in critically ill stroke patients: a MIMIC-IV study

作者：Dong Sun, Sichun Chen, Ying Bi, Shuang Wu, Yu Xie, Renwei Zhang, Lei Zhang, Bitang Dan, Huagang Li, Yang Liu, Yumin Liu, Bin Mei, Li Juan Zou · 发表于：Frontiers in Neurology · 年份：2025 · DOI：10.3389/fneur.2025.1584368 · 被引用次数：1 · 研究领域：Nutrition and Health in Aging、Inflammatory Biomarkers in Disease Prognosis、Venous Thromboembolism Diagnosis and Management

Introduction Stroke remains a leading cause of mortality and disability worldwide, with critically ill patients facing particularly poor outcomes. Existing prognostic markers often fail to capture the full spectrum of metabolic and nutritional disturbances in stroke. The serum creatinine-to-albumin ratio (sCAR), reflecting renal function and nutritional status, may offer improved mortality prediction for the intensive care unit (ICU)-admitted stroke patients. Methods This retrospective cohort study used the MIMIC-IV database (v2.2) to analyze 2,819 adult stroke patients admitted to the ICU. Patients were stratified into low- and high-sCAR groups based on an optimal cutoff of 0.419. Predictive performance was assessed using Cox regression, Kaplan–Meier survival analysis, and ROC and RCS curve modeling. Results Patients in the high sCAR group (≥0.419) demonstrated significantly higher short- and long-term mortality, including 28-day (31.7% vs. 16.7%, p < 0.001) and 1-year mortality (51.0% vs. 27.6%, p < 0.001). Multivariate Cox regression confirmed that elevated sCAR was independently associated with increased mortality risk at all endpoints, including 28-day (HR = 2.68, 95% CI: 2.28–3.14, p < 0.001) and 1-year (HR = 3.01, 95% CI: 2.61–3.47, p < 0.001). ROC analysis showed sCAR outperformed traditional markers, with an AUC of 0.618 for 28-day mortality and 0.639 for 1-year mortality. RCS curves revealed a non-linear association between sCAR and morta...