Abstract
The relationship between serum albumin-to-creatinine ratio (sACR) and in-hospital mortality (IHM), long-term mortality (LTM), and severe disorder of consciousness (SDOC) in patients with intracerebral hemorrhage (ICH) remains unclear. This study, based on the MIMIC-IV database, aimed to investigate the association between sACR and the risks of IHM, LTM, and SDOC. A total of 1,233 patients with ICH were encompassed. Kaplan-Meier (KM) survival curves demonstrated significant differences in the occurrence of SDOC and in-hospital and long-term survival among sACR strata. The Receiver Operating Characteristic (ROC) curve analysis demonstrated that sACR exhibited a strong predictive performance for IHM, LTM, and SDOC. Cox proportional hazards analysis further indicated that higher sACR levels were associated with reduced risks of both IHM and LTM. Moreover, restricted cubic spline (RCS) analysis, after full adjustment for potential confounders, revealed a linear inverse relationship between elevated sACR and the risks of SDOC and IHM, while no significant nonlinear association was observed with LTM. The protective effect of sACR continued to strengthen when sACR exceeded 4, but tended to plateau when sACR reached or surpassed 5. Subgroup analysis demonstrated that sACR exhibited an interaction effect with venous thromboembolism (VTE) on IHM, and also showed an interaction effect with a history of cancer on LTM. These findings suggest that higher sACR levels are significantly associated with a reduced risk of IHM and LTM among patients with severe ICH. Nonetheless, further prospective studies are needed to confirm these causal relationships.