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

Biomarkers DO NOTHING FOR RECOVERY! Because you don't have recovery protocols mapped to the problems found. Can't anyone in stroke think at all?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

Send me personal hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name(If you can't stand by your name don't bother replying anonymously) and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely state EXACTLY WHY you aren't working on 100% recovery protocols with NO EXCUSES!

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

Dong Sun^1†Sichun Chen^1†Ying Bi¹Shuang Wu¹Yu Xie¹Renwei Zhang¹Lei Zhang¹Bitang Dan¹Huagang Li¹Yang Liu²Yumin Liu¹Bin Mei^1*Li Zou^1*

• ¹Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
• ²Economics and Management School of Wuhan University, Wuhan, Hubei, China

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 mortality risk, with thresholds indicating elevated risk for both short- and long-term outcomes.

Conclusion: The sCAR is a powerful and clinically relevant biomarker for mortality prediction in critically ill stroke patients. By integrating renal and nutritional assessments, sCAR enhances early risk stratification and supports individualized ICU management.