The predictive implications for stroke-associated infection and prognostic outcome of neutrophil to albumin ratio in Chinese patients with spontaneous intracerebral hemorrhage

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Introduction The Neutrophil to Albumin Ratio (NAR) stands out as a novel integrative inflammatory biomarker that is associated with the occurrence of stroke-associated infection (SAI). Our objective is to comprehensively investigate the predictive capacity of NAR regarding the incidence of SAI and poor functional outcomes after spontaneous intracerebral hemorrhage (sICH).Methods We retrospectively enrolled 291 patients categorized into tertiles based on their NAR levels. Cox Proportional Hazards regressions, Kaplan-Meier curves with log-rank tests, and restricted cubic splines were utilized to elucidate the associations between NAR and SAI. Logistic regressions were used to investigate the associations between the poor functional outcome and NAR. To determine the role of SAI in the effect of NAR on the risk of poor functional outcome, mediation analyses were performed. The improvements in model discriminations and calibrations by incorporating NAR into ICH score and max-ICH score were comprehensively explored.Results With each standard deviation increase in NAR after full adjustments, the risks of SAI and poor functional outcome at 3 months rose by 43% and 76%, respectively. Furthermore, incorporating NAR into the ICH score and max-ICH score enhanced both the discrimination and calibration of model performance. Intriguingly, the proportion of the total effect mediated was 9.89% and 10.25% for poor functional outcome at 3 months (p = 0.010) and 1 year (p = 0.024).Conclusion Elevated NAR is a superior biomarker capable of predicting SAI and poor functional outcome after sICH. The association between NAR and the functional outcome is mildly yet significantly mediated by SAI.

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