High C-Reactive Protein/ Albumin Ratio Predicts Mortality and Hemorrhage in Stroke Patients Undergoing Mechanical Thrombectomy: A Systematic Review and Meta-Analysis

BACKGROUND: Stroke outcomes are multifactorial, and the C-Reactive Protein/Albumin Ratio (CAR) has emerged as a potential prognostic marker. This study aims to evaluate CAR prognostic significance in stroke. METHODS: Systematic searches across ScienceDirect, Medline, and Cochrane databases identified longitudinal studies. Unfavorable outcomes, including poor prognosis (mRS >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. RESULTS: The meta-analysis included 12 cohort studies comprising 5,042 participants. Elevated CAR (OR: 1.72; 95%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 (MT) (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 (AUC) 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]. CONCLUSIONS: Elevated 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 MT.