• de LiyisBryan GervaisBGFaculty of Medicine, Udayana University, Denpasar, Bali, Indonesia. Electronic address: bgliyis@gmail.com., ArdhaputraGede Yudha BaskaraGYBFaculty of Faculty of Medicine and Health S... more ciences, Warmadewa University, Denpasar, Bali, Indonesia., Sulaiman Liyis, Desak Made Wihandani, SiahaanYusak Mangara TuaYMTDepartment of Neurology, Faculty of Medicine, Pelita Harapan University, Karawaci, Tangerang, Indonesia., and PinatihKomang Januartha PutraKJPDepartment of Clinical Microbiology, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia.. less
• Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia. Electronic address: bgliyis@gmail.com.
• World Neurosurg. 2024 Aug 1; 188: 211219.e1211-219.e1.

BackgroundStroke outcomes are multifactorial, and the C-Reactive Protein to Albumin Ratio (CAR) has emerged as a potential prognostic marker. This study aims to evaluate CAR prognostic significance in stroke.MethodsSystematic searches across ScienceDirect, Medline, and Cochrane databases identified longitudinal studies. Unfavorable outcomes, including poor prognosis (modified rankin scale> 2), mortality, and severe complications like hemorrhage or restenosis, were considered. Analyses for unfavorable outcomes were conducted based on prior intervention, stroke type, and outcome type.ResultsThe meta-analysis included 12 cohort studies comprising 5042 participants. Elevated CAR (OR: 1.72; 95% confidence interval [CI]: 1.17-2.52; P = 0.01) and CRP (OR: 1.91; 95% CI: 1.31-2.77; P < 0.001) levels on admission were associated with unfavorable outcomes; no such association was observed for albumin (OR: 0.66; 95%CI: 0.24-1.80; P = 0.42). Elevated CAR levels were associated with unfavorable outcomes in patients undergoing mechanical thrombectomy (odds ratio [OR]: 2.70; 95% CI: 1.14-6.38; P < 0.02) and those with ischemic stroke (OR: 1.99; 95% CI: 1.24-3.18; P < 0.001), but no significant association was found in patients with hemorrhagic stroke. Furthermore, concerning specific outcomes, high CAR levels were associated with mortality (OR: 1.71; 95% CI: 1.00-2.95; P = 0.05) and hemorrhage (OR: 6.02; 95% CI: 1.61-23.87; P = 0.05). The area under the curve for CAR was 0.72 (0.68-0.76), with a sensitivity of 0.61 (0.49-0.71) and specificity of 0.73 (0.64-0.81).ConclusionsElevated CAR emerges as an effective marker in assessing unfavorable outcomes in stroke patients with moderately high sensitivity and specificity. High CAR levels exhibited statistically significant mortality and hemorrhage in stroke patients undergoing mechanical thrombectomy.Copyright © 2024 Elsevier Inc. All rights reserved.

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