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

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The study analyzed 1,069 patients with traumatic brain injury (TBI), intracerebral hemorrhage (ICH), and aneurysmal subarachnoid hemorrhage (aSAH).
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Higher aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) was linked to poor outcomes, with an adjusted odds ratio of 1.34 in the overall cohort.
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In TBI, elevated AAR was a strong independent predictor of unfavorable outcomes, with an adjusted odds ratio of 2.15, increasing to 5.38 for severe cases.
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AAR showed no significant prognostic value in ICH or aSAH, indicating distinct pathophysiological mechanisms in these conditions.
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The findings suggest that AAR reflects systemic metabolic stress in TBI but is not a universal biomarker for all types of acute brain injury.

Frontiers In Neurology

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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