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Peer-reviewedCC BY 4.0Frontiers in Neurology

Elevated C-reactive protein-to-albumin ratio is associated with early neurological deterioration in acute ischemic stroke: a retrospective cohort study

  • Zheng Zhou1
  • Wenwen Xu2
  • Zhaoping Wu3
  • Tingting Duan3
  • Ming Yang3
  • Yueqi Xu4
  • Junnan Ye4
4 affiliations
  1. 1Department of Hematology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  2. 2Department of Neurosurgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  3. 3Department of Neurology, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  4. 4Department of Emergency, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
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Abstract

Background: Early neurological deterioration (END) is a frequent complication of acute ischemic stroke (AIS) that contributes to poor clinical outcomes. The C-reactive protein-to-albumin ratio (CAR) reflects systemic inflammation relative to albumin levels and may be associated with END. We evaluated the association between log ₂ -transformed CAR and END in patients with AIS.

Methods: We retrospectively analyzed 1,766 patients with AIS admitted between September 2016 to September 2022. END was defined as an increase of ≥2 points in the NIHSS motor item or total score within 72 h of admission. Associations between log₂-CAR and END were assessed using a multivariable logistic regression analysis. Generalized additive and two-piecewise regression models were used as exploratory analyses to assess potential non-linearity. ROC curves were used to compare CAR with established biomarkers and the A2DS2 score.

Conclusion: Higher CAR was independently associated with END in this cohort. CAR’s strongest predictive advantage was observed when compared with the A2DS2 clinical score, whereas superiority over CRP alone was not demonstrated. The possible threshold at a raw CAR of approximately 0.020 is exploratory and requires independent validation.

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Cite

BibTeXRIS
BibTeX
@article{zhou2026elevated,
  title = {{Elevated C-reactive protein-to-albumin ratio is associated with early neurological deterioration in acute ischemic stroke: a retrospective cohort study}},
  author = {Zheng Zhou and Wenwen Xu and Zhaoping Wu and Tingting Duan and Ming Yang and Yueqi Xu and Junnan Ye},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1880425},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1880425/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Elevated C-reactive protein-to-albumin ratio is associated with early neurological deterioration in acute ischemic stroke: a retrospective cohort study
AU  - Zheng Zhou
AU  - Wenwen Xu
AU  - Zhaoping Wu
AU  - Tingting Duan
AU  - Ming Yang
AU  - Yueqi Xu
AU  - Junnan Ye
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1880425
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1880425/full
AB  - Background: Early neurological deterioration (END) is a frequent complication of acute ischemic stroke (AIS) that contributes to poor clinical outcomes. The C-reactive protein-to-albumin ratio (CAR) reflects systemic inflammation relative to albumin levels and may be associated with END. We evaluated the association between log ₂ -transformed CAR and END in patients with AIS.  Methods: We retrospectively analyzed 1,766 patients with AIS admitted between September 2016 to September 2022. END was defined as an increase of ≥2 points in the NIHSS motor item or total score within 72 h of admission. Associations between log₂-CAR and END were assessed using a multivariable logistic regression analysis. Generalized additive and two-piecewise regression models were used as exploratory analyses to assess potential non-linearity. ROC curves were used to compare CAR with established biomarkers and the A2DS2 score.  Conclusion: Higher CAR was independently associated with END in this cohort. CAR’s strongest predictive advantage was observed when compared with the A2DS2 clinical score, whereas superiority over CRP alone was not demonstrated. The possible threshold at a raw CAR of approximately 0.020 is exploratory and requires independent validation.
SN  - 1664-2295
ER  -