Distinct prognostic value of aspartate-to-alanine aminotransferase ratio (AAR) in traumatic brain injury versus hemorrhagic stroke: a cohort study of 1,069 patients - Summary - MDSpire

Distinct prognostic value of aspartate-to-alanine aminotransferase ratio (AAR) in traumatic brain injury versus hemorrhagic stroke: a cohort study of 1,069 patients

  • By

  • Dilmurat Gheyret

  • Xiaotao Gao

  • Ziwei Zhou

  • Lei Li

  • Jinchao Wang

  • Xu Zhang

  • Haoran Jia

  • Shu Zhang

  • Mirzat Turhon

  • Maimaitili Aisha

  • Cong Wang

  • Yuhan Li

  • Yingsheng Wei

  • Shuo An

  • Jian Sun

  • Jianning Zhang

  • Hengjie Yuan

  • Ye Tian

  • June 4, 2026

  • 0 min

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Objective:

To examine 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), with a focus on comparing these conditions.

Key Findings:
  • Unfavorable outcomes occurred in 39.3% of patients.
  • Higher AAR was associated with poor outcomes in the overall cohort (adjusted OR 1.34, 95% CI: 1.07–1.66).
  • In TBI, elevated AAR was a robust independent predictor of poor outcomes (adjusted OR 2.15, 95% CI: 1.46–3.15).
  • AAR showed no significant prognostic value in ICH or aSAH (p = 0.746 and p = 0.810, respectively).
  • A significant dose–response relationship between AAR and unfavorable outcomes was observed (P for trend < 0.001).
Interpretation:

The prognostic value of AAR is heterogeneous, serving as a strong predictor in TBI but lacking utility in hemorrhagic stroke, indicating distinct pathophysiological mechanisms and highlighting the need for tailored clinical approaches.

Limitations:
  • Retrospective design may introduce bias.
  • Exclusion of patients with pre-existing liver disease limits generalizability.
  • Potential confounding factors not controlled for may affect results.
Conclusion:

AAR is a powerful predictor in TBI reflecting systemic metabolic stress, but not in hemorrhagic stroke, underscoring the importance of understanding the liver-brain axis in clinical settings.

Original Source(s)

Distinct prognostic value of aspartate-to-alanine aminotransferase ratio (AAR) in traumatic brain injury versus hemorrhagic stroke: a cohort study of 1,069 patients

  • by Dilmurat Gheyret, Xiaotao Gao, Ziwei Zhou, Lei Li, Jinchao Wang, Xu Zhang, Haoran Jia, Shu Zhang, Mirzat Turhon, Maimaitili Aisha, Cong Wang, Yuhan Li, Yingsheng Wei, Shuo An, Jian Sun, Jianning Zhang, Hengjie Yuan, Ye Tian

  • June 4, 2026

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