Advanced lung cancer inflammation index is associated with mortality in critically ill patients with non-traumatic cerebral hemorrhage

Existing prognostic tools for non-traumatic intracerebral hemorrhage (NCH) mainly focus on neurological injury severity but overlook systemic factors that cause secondary deterioration. This study aimed to evaluate the Advanced Lung Cancer Inflammation Index (ALI), a biomarker combining nutritional parameters (BMI, albumin) and inflammatory parameters (neutrophil-to-lymphocyte ratio, NLR), as a new prognostic indicator for NCH. It aimed to fill the gap in quantifying the synergy between inflammation and malnutrition in neurocritical care.In this retrospective cohort study, 1502 critically ill NCH patients from the MIMIC-IV database were analyzed. ALI was calculated as (BMI × Albumin)/NLR, and patients were divided into groups based on the quartiles of the log-transformed ALI. The outcomes measured were in-hospital, 90-day, and 1-year mortality. Multivariable logistic regression, ROC curve analysis, restricted cubic spline models, and subgroup analyses were used to assess the prognostic value of ALI.The results showed that lower ALI values could independently predict mortality at all time points. After comprehensive adjustment, a 1-unit increase in the log-transformed ALI was associated with a 26% reduction in in-hospital mortality (OR = 0.74, 95% CI: 0.64-0.86, P < 0.001). The fourth quartile (with the highest ALI) had 56% lower mortality compared to the first quartile (OR = 0.44, P = 0.001). ALI had a strong ability to distinguish in-hospital all-cause mortality (AUC = 0.853, 95% CI: 0.826-0.880, P < 0.001). A threshold effect was found (log-transformed ALI = 4.0), below which ALI was inversely related to mortality (P < 0.001), and above which the relationship leveled off. Subgroup analyses confirmed the consistency of these findings across different age groups, comorbidities, and organ dysfunctions (P for interaction > 0.05). In conclusion, ALI is a reliable prognosticator for NCH, reflecting the interaction between systemic inflammation and malnutrition. Its simplicity and potential for threshold-based stratification may help in personalized interventions. Further prospective validation of ALI-guided protocols is needed.