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<p>Acute kidney injury (AKI) is a severe complication in patients with intracerebral hemorrhage (ICH), however, effective biomarkers combining systemic inflammation and nutritional status for early AKI prediction are still needed. This study aimed to evaluate the association between NAR and AKI and to assess its predictive value in ICH patients.&#xa0;This multicenter retrospective cohort study included 8,016 ICH patients. NAR was calculated using routine laboratory data, and AKI was defined based on KDIGO criteria. Logistic regression models were used to evaluate the association between NAR and AKI. Receiver operating characteristic (ROC) analysis and restricted cubic spline models were applied to assess predictive performance and dose-response relationships, respectively. Additional analyses examined the association between NAR and 30-day mortality.&#xa0;Elevated NAR was independently associated with a higher risk of AKI (adjusted OR: 1.46, 95% CI: 1.34–1.59, <i>p</i> &lt; 0.001). Patients in the highest NAR quartile had a significantly increased AKI risk compared to those in the lowest quartile (adjusted OR: 2.83, 95%CI: 2.17–3.69, <i>p</i> &lt; 0.001). ROC analysis showed that NAR had an AUC of 0.64 (95% CI:0.62–0.65) for predicting AKI, which was modest but statistically superior to MLR (AUC 0.60, 95% CI: 0.58–0.62, DeLong <i>p</i> &lt; 0.001). High NAR patients had a substantially higher incidence of AKI than low NAR patients (20.98% vs. 9.93%; risk ratio 2.11, 95% CI: 1.89–2.39). Patients with elevated NAR faced increased moderate/severe AKI (χ² <i>p</i> &lt; 0.001) and were more likely to have higher 30-day mortality (adjusted OR: 1.50, 95% CI: 1.20–1.88, <i>p</i> &lt; 0.001). Subgroup and sensitivity analyses confirmed the robustness of these findings.&#xa0;NAR is a practical adjunct for early risk stratification for predicting AKI in patients with ICH. Routine assessment of NAR could improve early risk stratification and guide clinical intervention.</p>

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Predictive value of neutrophil-to-albumin ratio for the incidence of acute kidney injury in intracerebral hemorrhage patients

  • 期刊论文

  • 发表日期：

    2025年11月21日

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  • Quanhu Guo,
  • Ke Zhou,
  • Yile Li,
  • Jun Wan,
  • Fengrui Yang,
  • Fang Fang,
  • Jorge Luis Cuyubamba Dominguez,
  • Yu Zhang

摘要

Acute kidney injury (AKI) is a severe complication in patients with intracerebral hemorrhage (ICH), however, effective biomarkers combining systemic inflammation and nutritional status for early AKI prediction are still needed. This study aimed to evaluate the association between NAR and AKI and to assess its predictive value in ICH patients. This multicenter retrospective cohort study included 8,016 ICH patients. NAR was calculated using routine laboratory data, and AKI was defined based on KDIGO criteria. Logistic regression models were used to evaluate the association between NAR and AKI. Receiver operating characteristic (ROC) analysis and restricted cubic spline models were applied to assess predictive performance and dose-response relationships, respectively. Additional analyses examined the association between NAR and 30-day mortality. Elevated NAR was independently associated with a higher risk of AKI (adjusted OR: 1.46, 95% CI: 1.34–1.59, p < 0.001). Patients in the highest NAR quartile had a significantly increased AKI risk compared to those in the lowest quartile (adjusted OR: 2.83, 95%CI: 2.17–3.69, p < 0.001). ROC analysis showed that NAR had an AUC of 0.64 (95% CI:0.62–0.65) for predicting AKI, which was modest but statistically superior to MLR (AUC 0.60, 95% CI: 0.58–0.62, DeLong p < 0.001). High NAR patients had a substantially higher incidence of AKI than low NAR patients (20.98% vs. 9.93%; risk ratio 2.11, 95% CI: 1.89–2.39). Patients with elevated NAR faced increased moderate/severe AKI (χ² p < 0.001) and were more likely to have higher 30-day mortality (adjusted OR: 1.50, 95% CI: 1.20–1.88, p < 0.001). Subgroup and sensitivity analyses confirmed the robustness of these findings. NAR is a practical adjunct for early risk stratification for predicting AKI in patients with ICH. Routine assessment of NAR could improve early risk stratification and guide clinical intervention.