Albumin-Anchored Thromboinflammatory Ratios Provide Modest Incremental Prognostic Value Beyond Clinical Severity Scores in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Study

Aneurysmal subarachnoid hemorrhage (aSAH) remains associated with substantial mortality and functional disability despite advances in neurosurgical and intensive care management. Systemic inflammation and thromboinflammatory activation play key roles in early brain injury and secondary complications. We aimed to evaluate the prognostic value of albumin-anchored inflammatory ratios—C-reactive protein/Albumin ratio (CAR) and D-dimer-to-Albumin Ratio (DAR)—for predicting functional outcome and in-hospital mortality in patients with aSAH. In this retrospective multicenter cohort study, 212 adult patients with radiologically confirmed aSAH were included. Admission laboratory parameters obtained within the first 24 h were analyzed. The primary outcome was poor functional status at discharge (modified Rankin Scale [mRS] ≥ 3); the secondary outcome was in-hospital mortality. Univariable and multivariable logistic regression analyses were performed. Discriminatory performance was evaluated using receiver operating characteristic (ROC) analysis, and incremental prognostic value was assessed through model comparison, calibration analysis, and decision curve analysis. Poor functional outcome occurred in 88 patients (41.5