Prognostic value of dynamic changes in C‑reactive protein‑albumin ratio for patients with spontaneous intracerebral hemorrhage

Background To examine the predictive value of the C‑reactive protein‑albumin ratio (CAR) measured at distinct time points.Methods Multivariate logistic regression was applied to examine the links of CAR 1 (at admission), CAR 2 (7th day after admission), and ΔCAR (change between CAR 1 and CAR 2) with 3-month prognosis.Results CAR 2 (AUC = 0.704, 95%CI: 0.650–0.757) yielded a statistically significantly higher predictive performance for the 3-month prognosis relative to CAR 1 (AUC = 0.624, 95%CI: 0.563–0.685) and ΔCAR (AUC = 0.624, 95%CI: 0.563–0.685) (for CAR 1 or ΔCAR vs. CAR 2, both p < 0.05). The ICH score + CAR 2 (AUC = 0.817, 95%CI: 0.764–0.869) provided significantly increased predictive efficacy versus the ICH score alone (AUC = 0.776, 95%CI: 0.717–0.835) (p = 0.018). Similarly, the predictive performance of the ICH index + CAR 2 (AUC = 0.810, 95%CI: 0.762–0.859) surpassed that of the ICH index alone (AUC = 0.772, 95%CI: 0.721–0.823) (p = 0.004).Conclusions CAR measured on the 7th day of admission was markedly linked to a poor 3-month prognosis and significantly increased predictive efficacy of existing prognostic scoring systems for patients with ICH. All observed associations and predictive advantages of day-7 CAR are derived from retrospective single-center data; prospective, multicenter cohort studies with independent external datasets are mandatory to verify our findings before any clinical translational use.