Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study
BackgroundRecent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause morta...
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1567767/full |
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| author | Tao Zheng Mengmeng Guo Yating Han Guanglu Li Xianhua Wang Shenjie Li Yuting Gao Wenxiong Tang Zunjing Liu |
| author_facet | Tao Zheng Mengmeng Guo Yating Han Guanglu Li Xianhua Wang Shenjie Li Yuting Gao Wenxiong Tang Zunjing Liu |
| author_sort | Tao Zheng |
| collection | DOAJ |
| description | BackgroundRecent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause mortality in critically ill patients with IS.MethodsCritically ill patients with IS were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) Version 3.0 database, and classified into quartiles based on APAR index levels. Clinical outcomes included all-cause mortality at 28-days, 90-days and 365-days after admission. Cox proportional hazards regression analysis and restricted cubic spline method were used to clarify the relationship between APAR index and clinical outcomes in critically ill patients with IS.ResultsA total of 1,690 critically ill patients with IS were selected from the MIMIC-IV database. Multivariate Cox proportional hazard analysis showed that increased APAR index was significantly associated with all-cause mortality. After adjusting for potential confounding factors, patients with higher APAR (Q4: 1.524–2.794) had significantly increased all-cause mortality at 28-days, 90-days, and 365-days after admission (HR 2.05, 95%CI 1.47–2.86, p = 0; HR 2.09, 95%CI 1.53–2.85, p = 0; HR 2.11, 95%CI 1.55–2.87, p = 0). APAR had a linear relationship with 28-days and 365-days mortality (P for non-linearity: 0.098 and 0.051), but a nonlinear relationship with 90-days mortality (P for non-linearity: 0.042). Subgroup analyses further revealed that higher APAR was also associated with increased long-term mortality in IS patients without hypertension, DM, cardiovascular disease, liver disease or CKD. In addition, we did not observe any interaction between subgroup variables and APAR.ConclusionA higher APAR index was significantly associated with increased all-cause mortality at 28-days, 90-days and 365-days after admission for critically ill patients with IS. The APAR index may help identify patients with IS at high risk of all-cause death. |
| format | Article |
| id | doaj-art-6869a0717e9540899c31a5bc40478da7 |
| institution | OA Journals |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-04-01 |
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| spelling | doaj-art-6869a0717e9540899c31a5bc40478da72025-08-20T02:20:12ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-04-011610.3389/fneur.2025.15677671567767Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective studyTao Zheng0Mengmeng Guo1Yating Han2Guanglu Li3Xianhua Wang4Shenjie Li5Yuting Gao6Wenxiong Tang7Zunjing Liu8Beijing University of Chinese Medicine, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaBeijing University of Chinese Medicine, Beijing, ChinaBeijing University of Chinese Medicine, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaDepartment of Neurology, China-Japan Friendship Hospital, Beijing, ChinaDepartment of Neurology, Peking University People’s Hospital, Beijing, ChinaBackgroundRecent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause mortality in critically ill patients with IS.MethodsCritically ill patients with IS were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) Version 3.0 database, and classified into quartiles based on APAR index levels. Clinical outcomes included all-cause mortality at 28-days, 90-days and 365-days after admission. Cox proportional hazards regression analysis and restricted cubic spline method were used to clarify the relationship between APAR index and clinical outcomes in critically ill patients with IS.ResultsA total of 1,690 critically ill patients with IS were selected from the MIMIC-IV database. Multivariate Cox proportional hazard analysis showed that increased APAR index was significantly associated with all-cause mortality. After adjusting for potential confounding factors, patients with higher APAR (Q4: 1.524–2.794) had significantly increased all-cause mortality at 28-days, 90-days, and 365-days after admission (HR 2.05, 95%CI 1.47–2.86, p = 0; HR 2.09, 95%CI 1.53–2.85, p = 0; HR 2.11, 95%CI 1.55–2.87, p = 0). APAR had a linear relationship with 28-days and 365-days mortality (P for non-linearity: 0.098 and 0.051), but a nonlinear relationship with 90-days mortality (P for non-linearity: 0.042). Subgroup analyses further revealed that higher APAR was also associated with increased long-term mortality in IS patients without hypertension, DM, cardiovascular disease, liver disease or CKD. In addition, we did not observe any interaction between subgroup variables and APAR.ConclusionA higher APAR index was significantly associated with increased all-cause mortality at 28-days, 90-days and 365-days after admission for critically ill patients with IS. The APAR index may help identify patients with IS at high risk of all-cause death.https://www.frontiersin.org/articles/10.3389/fneur.2025.1567767/fullalbuminalkaline phosphataseAPARischemic strokemortalitybiomarker |
| spellingShingle | Tao Zheng Mengmeng Guo Yating Han Guanglu Li Xianhua Wang Shenjie Li Yuting Gao Wenxiong Tang Zunjing Liu Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study Frontiers in Neurology albumin alkaline phosphatase APAR ischemic stroke mortality biomarker |
| title | Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study |
| title_full | Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study |
| title_fullStr | Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study |
| title_full_unstemmed | Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study |
| title_short | Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study |
| title_sort | association of alkaline phosphatase albumin ratio with all cause mortality in critically ill patients with ischemic stroke a retrospective study |
| topic | albumin alkaline phosphatase APAR ischemic stroke mortality biomarker |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1567767/full |
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