ArticleFrontiers in neurology
Distinct prognostic value of aspartate-to-alanine aminotransferase ratio (AAR) in traumatic brain injury versus hemorrhagic stroke: a cohort study of 1,069 patients.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The liver-brain axis influences outcomes after acute brain injury, yet the prognostic significance of liver markers across varying injury types remains unclear. We examined the disease-specific prognostic value of the aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) in traumatic brain injury (TBI), intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (aSAH). Methods: This retrospective cohort study included 1,069 consecutive patients (413 TBI, 490 ICH, 166 aSAH). The primary outcome was unfavorable neurological status at discharge (modified Rankin Scale 3-6). Multivariable logistic regression and formal interaction testing assessed the heterogeneity of AAR's effect across disease types. Results: Unfavorable outcomes occurred in 420 patients (39.3%). Higher AAR was associated with poor outcomes in the overall cohort (adjusted OR 1.34, 95% CI: 1.07-1.66). However, significant effect modification by disease type was observed (P for interaction = 0.001). In TBI, elevated AAR was a robust independent predictor (adjusted OR 2.15, 95% CI: 1.46-3.15, Conclusion: The prognostic value of AAR is highly heterogeneous. It serves as a powerful predictor in TBI-likely reflecting systemic metabolic stress-but lacks utility in hemorrhagic stroke. These findings suggest distinct pathophysiological mechanisms driving liver-brain interactions across neurosurgical conditions, cautioning against a "one-size-fits-all" biomarker approach.
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