Admission monocyte-to-albumin ratio (MAR) is independently associated with 30-day mortality in elderly spontaneous intracerebral hemorrhage patients, although its discriminative ability is limited (AUC 0.648), suggesting it may serve as a supplementary—not standalone—bedside risk stratification tool.
30-day all-cause mortality in elderly patients with spontaneous intracerebral hemorrhage was 38.8% in this cohort.
MAR was significantly higher in non-survivors compared to survivors at admission.
The optimal MAR cutoff for predicting 30-day mortality was 0.021, determined by Youden's index.
MAR performance was comparable to other inflammatory markers for predicting 30-day mortality.
MAR > 0.021 was independently associated with 30-day mortality after multivariable adjustment.
The study design was a single-center retrospective analysis limited to an exclusively elderly cohort (aged ≥65 years).
This research suggests that a simple blood test ratio—the monocyte-to-albumin ratio (MAR), which combines a marker of inflammation (monocytes) with a marker of nutritional status (albumin)—can help identify elderly stroke patients who are at higher risk of dying within 30 days of a brain bleed (spontaneous intracerebral hemorrhage). Among 206 patients aged 65 and older admitted with this type of stroke, nearly 4 in 10 died within a month. Patients who died had notably higher MAR values at admission, and those with a MAR above 0.021 were more than twice as likely to die within 30 days compared to those with lower values, even after accounting for other important risk factors. However, the study found that MAR is not a highly precise predictor on its own—its ability to distinguish survivors from non-survivors (measured by the AUC of 0.648) was only modest, and it performed similarly to other inflammation-based ratios already used in clinical practice. This means it would miss many high-risk patients or flag some low-risk patients if used alone. The authors emphasize that MAR should be considered a supplementary tool to aid clinical judgment rather than a standalone decision-making instrument. The practical implication is that because MAR is calculated from routine blood tests already ordered in hospital admissions, it costs nothing extra to compute and could be incorporated into initial risk assessments for elderly brain bleed patients. This research suggests further prospective and multicenter studies are needed to confirm these findings and determine how best to combine MAR with other clinical information to improve prediction of outcomes in this vulnerable population.
Gong L, Liu F, Zhao K, Zhao H, Guo S, Zhang S. (2026). Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with spontaneous intracerebral hemorrhage: a retrospective analysis.. Frontiers in neurology. https://doi.org/10.3389/fneur.2026.1948936