# From Stroke to Infection: The Emerging Role of Fibrinogen-to-Albumin Ratio in Predicting Stroke-Associated Pneumonia

## TL;DR

This study shows that the fibrinogen-to-albumin ratio can predict pneumonia in stroke patients with high accuracy.

## Contribution

The study introduces the fibrinogen-to-albumin ratio as a novel, highly accurate predictor of stroke-associated pneumonia.

## Key findings

- FAR distinguished SAP patients from controls with 95.5% sensitivity and 100% specificity.
- FAR also distinguished AIS-only patients from controls with 81.8% sensitivity and 95.5% specificity.
- FAR shows potential for early risk stratification and prediction of SAP in stroke patients.

## Abstract

Background: Stroke-associated pneumonia (SAP) is a commonly encountered complication in patients with acute ischemic stroke (AIS) and is generally manifested within the first week following stroke onset.

Aims: The objectives of this study were to determine the association of the fibrinogen-to-albumin ratio (FAR) with SAP in AIS and to examine the predictive and prognostic utility of FAR for the development of SAP.

Methods: We performed a prospective cohort study involving 44 men with AIS admitted to the stroke unit within 24 hours of onset and followed up for two weeks. Based on clinical outcomes, individual patients were classified into SAP and non-SAP groups, in addition to another 22 age-matched healthy controls. Clinical characteristics, laboratory data, and outcomes were compared for differences, and receiver operating characteristic (ROC) curves were also constructed to observe the predictive capacity of FAR.

Results: FAR uniquely distinguished the SAP group from controls with a 95.5% sensitivity and a 100% specificity at a cutoff of 0.079 (area under the curve (AUC)=0.997; p<0.001). FAR also distinguished AIS-only patients from controls with an 81.8% sensitivity and a 95.5% specificity at a cutoff of 0.072 (AUC=0.946; p<0.001).

Conclusion: FAR is a simple, robust biomarker and may independently predict the risk of SAP in AIS patients. Its very high discriminative accuracy for distinguishing SAP from both non-SAP stroke and healthy controls supports its rationale in early risk stratification and prediction. Usage of FAR in clinical assessment could facilitate the early detection of such patients, allow scope for therapeutic intervention based on individual risk, and reduce SAP-related morbidity.