Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with spontaneous intracerebral hemorrhage: a retrospective analysis.

Authors

Lihui Gong, Fenglin Liu, Keyi Zhao, Haoshuang Zhao, Sujun Guo, Santao Zhang

Published in

Frontiers in neurology. Volume 17. Pages 1948936. Epub Sep 30, 2026.

Abstract

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.
This single-center retrospective study included 206 consecutive elderly patients with acute sICH. MAR was calculated as monocyte count (×10⁹/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.
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).
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.

PMID:
42876556
Bibliographic data and abstract were imported from PubMed on 15 Oct 2026.

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