Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with…

Abstract

Background: The monocyte-to-albumin ratio (MAR) integrates systemic inflammation and nutritional status and has been proposed as a predictor of mortality after spontaneous intracerebral hemorrhage (sICH). However, independent validation in an exclusively elderly cohort remains limited. We aimed to evaluate the association between admission MAR and 30-day mortality in patients aged ≥65 years with sICH.

Methods: This single-center retrospective study included 206 consecutive elderly patients with acute sICH. MAR was calculated as monocyte count (×10 ⁹ /L) divided by serum albumin (g/L). The primary outcome was 30-day all-cause mortality. Optimal MAR cutoff was determined by Youden’s index. Kaplan–Meier and multivariable Cox regression analyses were performed.

Results: 30-day mortality was 38.8%. MAR was significantly higher in non-survivors (0.022 vs. 0.016, p < 0.001). The optimal cutoff was 0.021 (AUC 0.648, 95% CI 0.572–0.724), providing sensitivity of 57.5% and specificity of 68.3%. MAR performance was comparable to the neutrophil-to-lymphocyte ratio (AUC 0.643) and systemic inflammatory response index (AUC 0.637). After adjustment, MAR > 0.021 was independently associated with 30-day mortality (adjusted HR 2.41, 95% CI 1.51–3.85, p < 0.001). In a sensitivity analysis using the ICH score as the primary severity covariate, MAR remained independently associated with mortality (adjusted HR 2.02, 95% CI 1.25–3.26, p = 0.004).

Conclusion: Admission MAR is independently associated with 30-day mortality in elderly sICH patients, although its discriminative ability is limited (AUC 0.648). As a simple, routinely available parameter, MAR may serve as a supplementary—not standalone—bedside risk stratification tool.

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BibTeX

@article{gong2026predictive,
  title = {{Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with spontaneous intracerebral hemorrhage: a retrospective analysis}},
  author = {Lihui Gong and Fenglin Liu and Keyi Zhao and Haoshuang Zhao and Sujun Guo and Santao Zhang},
  journal = {Frontiers in neurology},
  year = {2026},
  month = sep,
  doi = {10.3389/fneur.2026.1948936},
  url = {https://europepmc.org/article/PMC/PMC13661444},
  note = {CC BY},
}

RIS

TY  - JOUR
TI  - Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with spontaneous intracerebral hemorrhage: a retrospective analysis
AU  - Lihui Gong
AU  - Fenglin Liu
AU  - Keyi Zhao
AU  - Haoshuang Zhao
AU  - Sujun Guo
AU  - Santao Zhang
PY  - 2026
DA  - 2026/09/30
JO  - Frontiers in neurology
DO  - 10.3389/fneur.2026.1948936
UR  - https://europepmc.org/article/PMC/PMC13661444
AB  - Background: The monocyte-to-albumin ratio (MAR) integrates systemic inflammation and nutritional status and has been proposed as a predictor of mortality after spontaneous intracerebral hemorrhage (sICH). However, independent validation in an exclusively elderly cohort remains limited. We aimed to evaluate the association between admission MAR and 30-day mortality in patients aged ≥65 years with sICH.  Methods: This single-center retrospective study included 206 consecutive elderly patients with acute sICH. MAR was calculated as monocyte count (×10 ⁹ /L) divided by serum albumin (g/L). The primary outcome was 30-day all-cause mortality. Optimal MAR cutoff was determined by Youden’s index. Kaplan–Meier and multivariable Cox regression analyses were performed.  Results: 30-day mortality was 38.8%. MAR was significantly higher in non-survivors (0.022 vs. 0.016, p &lt; 0.001). The optimal cutoff was 0.021 (AUC 0.648, 95% CI 0.572–0.724), providing sensitivity of 57.5% and specificity of 68.3%. MAR performance was comparable to the neutrophil-to-lymphocyte ratio (AUC 0.643) and systemic inflammatory response index (AUC 0.637). After adjustment, MAR &gt; 0.021 was independently associated with 30-day mortality (adjusted HR 2.41, 95% CI 1.51–3.85, p &lt; 0.001). In a sensitivity analysis using the ICH score as the primary severity covariate, MAR remained independently associated with mortality (adjusted HR 2.02, 95% CI 1.25–3.26, p = 0.004).  Conclusion: Admission MAR is independently associated with 30-day mortality in elderly sICH patients, although its discriminative ability is limited (AUC 0.648). As a simple, routinely available parameter, MAR may serve as a supplementary—not standalone—bedside risk stratification tool.
SN  - 1664-2295
ER  -

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