{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:05Z","timestamp":1791175985248,"version":"4.1.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The independent and joint associations of admission C-reactive protein-to-albumin ratio (CAR) and serum creatinine with mortality in tuberculous meningitis (TBM) remain uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed a single-center retrospective cohort of non-HIV patients hospitalized with TBM from October 2013 to January 2024. Exposure measurements were the first tests within 24\u2005h of admission, before acute interventions. Multivariable logistic regression modeled both exposures continuously, adjusted for age nonlinearly and prespecified covariates, and tested exposure nonlinearity and interaction. Covariate-only multiple imputation generated 20 datasets. Cohort-specific upper-quartile groups were descriptive. An adult sensitivity analysis used estimated glomerular filtration rate (eGFR) calculated with the 2021 CKD-EPI equation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,574 eligible patients, 187 died in hospital. The primary analysis included 1,563 patients and all 187 deaths; 11 survivors lacked CAR (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) or creatinine (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20098), without overlap. Creatinine showed evidence of nonlinearity (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.022), whereas CAR did not (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.105). The linear CAR estimate was near the null (adjusted odds ratio [OR] per doubling, 1.02; 95% confidence interval [CI] 0.88\u20131.18); the interaction\n                      <jats:italic>P<\/jats:italic>\n                      value was 0.065. Relative to serum creatinine of 48\u2005\u00b5mol\/L, adjusted ORs for death were 1.31 (95% CI: 1.11\u20131.55) at 65\u2005\u00b5mol\/L, 1.49 (1.15\u20131.92) at 80\u2005\u00b5mol\/L, and 1.62 (1.17\u20132.24) at 100\u2005\u00b5mol\/L. Descriptive group mortality ranged from 9.02% when both markers were below their 75th percentiles to 19.38% when both were at or above them. Among 1,372 adults, the OR per 10\u2005mL\/min\/1.73\u2005m\n                      <jats:sup>2<\/jats:sup>\n                      lower eGFR was 1.045 (0.984\u20131.109;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.150).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Admission creatinine had a nonlinear adjusted association with in-hospital mortality in non-HIV TBM. CAR yielded a near-null linear estimate, and the interaction analysis did not establish effect modification. Unmeasured neurological severity limits interpretation; these results do not define kidney dysfunction, a clinical cutoff, or a clinically useful prediction model.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1905776","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:33:27Z","timestamp":1791174807000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Admission C-reactive protein-to-albumin ratio and serum creatinine in relation to in-hospital mortality in non-HIV tuberculous meningitis: a retrospective cohort study"],"prefix":"10.3389","volume":"13","author":[{"given":"Wengao","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Neurology, The Second Hospital of Changsha (West Branch of Changsha Hospital for Maternal & Child Health Care)","place":["Changsha, Hunan, 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jue","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China","place":["Changsha, Hunan, 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