J Int Med Res. 2026 Jul;54(7):3000605261448081. doi: 10.1177/03000605261448081. Epub 2026 Jul 3.
ABSTRACT
BackgroundPostoperative bleeding in patients with intracranial aneurysms remains a serious complication associated with high mortality. The platelet-to-albumin ratio, reflecting thrombotic potential and endothelial health, has demonstrated prognostic value in various clinical settings. However, its association with postoperative bleeding following endovascular treatment of intracranial aneurysms has not yet been investigated.MethodsThis retrospective cohort study (January 2021 to January 2025) included 219 participants undergoing endovascular treatment. Multivariable logistic regression, smooth curve fitting, and piecewise linear regression were used to assess the association between the platelet-to-albumin ratio and bleeding risk, adjusting for potential confounders. Predictive performance was evaluated using receiver operating characteristic curves and decision curve analysis.ResultsBleeding occurred in 58 participants (26.5%). A significant nonlinear inverse L-shaped relationship was observed between the platelet-to-albumin ratio and bleeding risk (nonlinearity p = 0.010), with an inflection point at the platelet-to-albumin ratio of 5.05. Below this threshold, a higher ratio was associated with reduced risk (odds ratio: 0.607, 95% confidence interval: 0.445-0.829, p = 0.0017); whereas above this value, the association was neutral. The incidence of bleeding decreased significantly across increasing platelet-to-albumin ratio quartiles (Q1: 45.5% vs. Q4: 14.3%, p < 0.001). Multivariable analysis confirmed platelet-to-albumin ratio as an independent predictor (continuous: odds ratio: 0.73, 95% confidence interval: 0.59-0.90, p = 0.004; Q4 vs. Q1: odds ratio: 0.05, 95% confidence interval: 0.01-0.21, p < 0.001). The platelet-to-albumin ratio demonstrated superior discriminative capacity (area under the curve, 0.670) compared with platelet count (area under the curve, 0.624) or albumin alone (area under the curve, 0.607). Decision curve analysis confirmed clinical application.ConclusionThe platelet-to-albumin ratio independently predicts postoperative bleeding with a nonlinear relationship. It should be considered an adjunctive marker within a multimodal framework to help balance bleeding and ischemic risks.
PMID:42399610 | DOI:10.1177/03000605261448081