• Erxing Tao, Zhixin Liu, Yihao Liu, Chengyun Wang, Genbo Huang, Chunhua Xu, and Zihan Ding.
• Department of Neurosurgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
• World Neurosurg. 2025 Jan 8; 194: 123546123546.

ObjectiveTo evaluate the effects of admission serum C-reactive protein-to-albumin ratio (CAR) in traumatic spinal cord injury (TSCI) severity evaluation and prognosis.MethodsWe included 402 TSCI patients from 2 hospitals and collected relevant clinical and laboratory data. The effects of CAR on the prognosis of TSCI were explored using univariate and multivariate logistic regression analyses. The predictive values of different indicators were compared by evaluating the areas under the receiver operating characteristic curve.ResultsWe classified 224 (55.7%) patients as severe TSCI (American spinal injury association Impairment Scale [AIS] grades A-B) and 178 (44.3%) patients as nonsevere TSCI (AIS grades C-E) according to the American Spinal Cord Injury Society Impairment Scale (AIS). Further investigation into the correlation among C-reactive protein (CRP), CAR, and serum albumin with the AIS grade showed that the admission CRP and CAR decreased in an AIS grade-dependent manner, while serum albumin increased in an AIS grade-dependent manner. Of the total patients, 226 (56.2%) were categorized as having a good clinical outcome based on AIS grade at the 1-year follow-up. Serum CAR decreased as follow-up AIS grade decreased. Serum CAR was more strongly correlated with follow-up AIS grade than serum CRP and serum albumin alone. Multivariate logistic regression analyses showed that injury severity and CAR were independent risk factors for poor prognosis. The area under the curve (AUC) of serum CAR was 0.749 higher than that of serum CRP (AUC = 0.736) and serum albumin (AUC = 0.719).ConclusionsSerum CAR is a readily available biomarker for assessing the severity of TSCI and predicting prognosis, which is clinically relevant for the functional recovery of patients with TSCI.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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