Abstract: Objective To investigate the correlations of fibrinogen-to-albumin ratio (Fib/Alb), soluble myeloid cell triggering receptor-like transcript factor-1 (sTLT-1) and neutrophil gelatinase-associated lipocalin (NGAL) in peripheral blood at admission with the risk of poor prognosis in patients with acute thoracoabdominal trauma and their early warning values. Methods A prospective study was conducted in 152 patients with acute thoracoabdominal trauma in the hospital from January 2022 to May 2024. The patients were divided into good prognosis group (n=120) and poor prognosis group (n=32) according to their prognosis. Baseline data and the levels of Fib/Alb, sTLT-1 and NGAL in peripheral blood at admission were compared between the two groups. The relationships between the levels of Fib/Alb, sTLT-1, and NGAL in peripheral blood at admission and the severity of traumathe Circulation, Respiration, Abdomen, Movement, and Speech (CRAMS) score and the risk of poor prognosis were analyzed. The early warning values of the levels of Fib/Alb, sTLT-1 and NGAL in peripheral blood at admission for the risk of poor prognosis were evaluated. Results The time from injury to admission in the poor prognosis group was longer than that in the good prognosis group, the CRAMS score, the Glasgow Coma Scale (GCS) score, and the levels of Fib, Alb and Fib/Alb in peripheral blood at admission in the poor prognosis group were lower than those in the good prognosis group, while the Sequential Organ Failure Assessment (SOFA) score and the levels of sTLT-1 and NGAL in peripheral blood at admission were higher than those in the good prognosis group, with statistically significant between-group differences (P < 0.05). The levels of Fib, Alb and Fib/Alb in peripheral blood at admission showed a decreasing trend, while the levels of sTLT-1 and NGAL showed an increasing trend in patients with mild, severe, and extremely severe trauma, with statistically significant differences (P < 0.05). Pearson correlation analysis showed that the level of Fib/Alb in peripheral blood at admission (r=0.839) was positively correlated with the CRAMS score, while the levels of sTLT-1 and NGAL (r=-0.832, -0.808) were negatively correlated with the CRAMS score (P < 0.05). Logistic regression analysis showed that after adjusting for confounding factors, the levels of Fib/Alb (OR=0.769), sTLT-1 (OR=1.562) and NGAL (OR=1.575) in peripheral blood at admission were still independently correlated with the risk of poor prognosis (P < 0.05). The receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) for the combined early warning of the risk of poor prognosis by the levels of Fib/Alb, sTLT-1, and NGAL in peripheral blood at admission was 0.918, which was superior to the early warning value of individual indicators (Z=2.992, 2.291, 2.082, P < 0.05). Conclusion The levels of Fib/Alb, sTLT-1 and NGAL in peripheral blood are closely related to the severity of trauma and prognosis in patients with acute thoracoabdominal trauma. Combined detection has a certain early warning value for the risk of poor prognosis and can be used as potential factors for clinical assessment of trauma condition and early warning of the risk of poor prognosis.