Distinct prognostic value of aspartate-to-alanine aminotransferase ratio (AAR) in traumatic brain injury…

Cohort studyFrontiers in neurology· 2026

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

Dilmurat Gheyret, Xiaotao Gao, Ziwei Zhou … Ye Tian

NeurotraumaCohort studyQ2IF 3.1

Elevated aminotransferase ratio strongly predicts poor outcome in traumatic brain injury, not hemorrhagic stroke

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

Dilmurat Gheyret … Ye Tian

Frontiers in neurology · 2026 · Q2 in Neurology

Background

The liver-brain axis influences outcomes after acute brain injury, yet the prognostic significance of liver markers across varying injury types remains unclear.

Methods

This retrospective cohort study included 1,069 consecutive patients (413 traumatic brain injury, 490 intracerebral hemorrhage, 166 aSAH).

n = 420 patients

Results

more than double the odds of poor outcome in traumatic brain injury

OR by subgroup · 95% CI

More results

Unfavorable outcomes occurred in 420 patients (39.3%).

Higher aminotransferase ratio 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).

More results

Conversely, aminotransferase ratio showed no significant prognostic value in intracerebral hemorrhage ( p = 0.746) or aSAH ( p = 0.810).

“

Conclusion · 1 of 2

The prognostic value of aminotransferase ratio is highly heterogeneous. It serves as a powerful predictor in traumatic brain injury-likely reflecting systemic metabolic stress-but lacks utility in hemorrhagic stroke.

Conclusion · 2 of 2

These findings suggest distinct pathophysiological mechanisms driving liver-brain interactions across neurosurgical conditions, cautioning against a "one-size-fits-all" biomarker approach.

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

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

Related papers