Yongjian Tian, Jun Liu, Dechun Zhu, Cui Li, Yue Liu, Wei Wang
Serum CAR and IL-6 independently correlate with brain injury severity and 28-day mortality after ICH, acting as easily accessible predictive biomarkers. Prospective research is necessary to verify their clinical utility for early risk stratification.
BACKGROUND: Intracerebral hemorrhage (ICH) carries high mortality, with neuroinflammation driving adverse outcomes. The C-reactive protein (CRP)-to-albumin (ALB) ratio (CAR) and interleukin-6 (IL-6) are promising neuroinflammatory markers for acute brain injury, yet their combined value for evaluating ICH injury severity and 28-day mortality prediction remains unclear.
METHODS: We enrolled 125 ICH patients admitted to Fuyang People's Hospital (July 2024-May 2026), split into 28-day survivors (n = 77) and non-survivors (n = 48). Admission serum CRP, ALB and IL-6 were tested. GCS score assessed brain injury severity, and ICH score stratified 28-day death risk. Baseline data were compared between groups. Spearman correlation analyzed links of CAR, IL-6 with GCS and ICH scores. Multivariate logistic regression identified independent predictors; ROC curve analysis was performed to evaluate the predictive performance of CAR, IL-6, and their combined model.
RESULTS: Serum CAR and IL-6 were markedly higher in 28-day non-survivors and rose progressively with aggravated brain injury and higher ICH mortality risk. The two biomarkers showed moderate negative correlations with GCS scores and weak positive correlations with ICH scores (all p < 0.05). Age, ICH score, GCS, CAR and IL-6 were significant in univariate regression. Separate multivariate logistic regression models adjusted for age, hematoma volume and admission GCS score showed that CAR (OR = 1.540, 95% CI: 1.092-2.172, p = 0.014) and IL-6 (OR = 3.940, 95% CI: 1.034-15.003, p = 0.044) independently predicted 28-day mortality. The combined CAR-IL-6 model yielded a raw AUC of 0.810, with individual AUC values of 0.702 for CAR and 0.718 for IL-6. DeLong's test revealed it performed significantly better than CAR alone (p = 0.035), and the model achieved a maximum Youden index of 0.558.
CONCLUSION: Serum CAR and IL-6 independently correlate with brain injury severity and 28-day mortality after ICH, acting as easily accessible predictive biomarkers. Prospective research is necessary to verify their clinical utility for early risk stratification.