Predictive value of the monocyte-to-albumin ratio at admission for 30-day mortality in elderly patients with spontaneous intracerebral hemorrhage: a retrospective analysis

Background The monocyte-to-albumin ratio (MAR) integrates systemic inflammation and nutritional status and has been proposed as a predictor of mortality after spontaneous intracerebral hemorrhage (sICH). However, independent validation in an exclusively elderly cohort remains limited. We aimed to evaluate the association between admission MAR and 30-day mortality in patients aged ≥65 years with sICH. Methods This single-center retrospective study included 206 consecutive elderly patients with acute sICH. MAR was calculated as monocyte count (×10 9 /L) divided by serum albumin (g/L). The primary outcome was 30-day all-cause mortality. Optimal MAR cutoff was determined by Youden’s index. Kaplan–Meier and multivariable Cox regression analyses were performed. Results 30-day mortality was 38.8%. MAR was significantly higher in non-survivors (0.022 vs. 0.016, p < 0.001). The optimal cutoff was 0.021 (AUC 0.648, 95% CI 0.572–0.724), providing sensitivity of 57.5% and specificity of 68.3%. MAR performance was comparable to the neutrophil-to-lymphocyte ratio (AUC 0.643) and systemic inflammatory response index (AUC 0.637). After adjustment, MAR > 0.021 was independently associated with 30-day mortality (adjusted HR 2.41, 95% CI 1.51–3.85, p < 0.001). In a sensitivity analysis using the ICH score as the primary severity covariate, MAR remained independently associated with mortality (adjusted HR 2.02, 95% CI 1.25–3.26, p = 0.004). Conclusion Admission MAR is independently associated with 30-day mortality in elderly sICH patients, although its discriminative ability is limited (AUC 0.648). As a simple, routinely available parameter, MAR may serve as a supplementary—not standalone—bedside risk stratification tool.