Table 5_Association between the serum albumin-to-creatinine ratio and 28-day all-cause mortality in sepsis: a retrospective cohort study.docx

ObjectiveThis study aimed to investigate the association between the serum albumin-to-creatinine ratio (ACR) and the prognosis of sepsis.
MethodsExtracted clinical data of sepsis patients from the MIMIC-IV (v2.2) database. Based on the optimal ACR cutoff value, we divided the cohort into two groups and preformed propensity score matching to balance baseline characteristics. Explored the relationship between ACR and 28-day all-cause mortality using Cox proportional risk regression and Kaplan–Meier survival curves, and conducted subgroup analysis to evaluate the effect modifications across different patient populations. Applied the restricted cubic spline (RCS) curves to assess the nonlinear relationships, and the receiver operating characteristic (ROC) curve to assess the predictive performance.
ResultsAfter screening and matching, a total of 1,418 sepsis patients were included. Cox regression and Kaplan–Meier analysis showed that a high ACR value might be associated with a low 28-day mortality risk. Subgroup analysis revealed a significant interaction between age and ACR, as well as renal disease and ACR. RCS analysis revealed a nonlinear association between ACR values and reduced mortality risk. When ACR was below 2,300, there was a negative association between ACR and mortality. However, no significant association was observed when ACR exceeded 2,300. ROC curve analysis indicated that combining ACR with age, sex, body mass index, SOFA score, white blood cell, hemoglobin, blood lactate improved the predictive performance for 28-day all-cause mortality (AUC = 0.730).
ConclusionA higher ACR value may associated with a lower 28-day all-cause mortality risk when ACR value was less than 2,300. Moreover, ACR had some predictive power for adverse outcomes in sepsis.

研究目的：本研究旨在探讨血清白蛋白与肌酐比值（albumin-to-creatinine ratio, ACR）与脓毒症患者预后的关联。
研究方法：从MIMIC-IV（v2.2）数据库中提取脓毒症患者的临床数据。基于最优ACR截断值将研究队列分为两组，并采用倾向性评分匹配法平衡基线特征。采用Cox比例风险回归模型与Kaplan-Meier生存曲线分析ACR与28天全因死亡率的关联，并进行亚组分析以评估不同患者人群中的效应修正作用。采用限制性立方样条（restricted cubic spline, RCS）曲线评估非线性关联，通过受试者工作特征（receiver operating characteristic, ROC）曲线评估预测性能。
研究结果：经筛选与匹配后，最终纳入1418例脓毒症患者。Cox回归与Kaplan-Meier分析结果显示，较高的ACR水平可能与较低的28天死亡率风险相关。亚组分析显示，年龄、肾脏疾病分别与ACR存在显著交互作用。RCS分析揭示ACR水平与死亡率降低风险间存在非线性关联：当ACR低于2300时，ACR与死亡率呈负相关；而当ACR超过2300时，未观察到显著关联。ROC曲线分析表明，将ACR与年龄、性别、体质量指数、序贯器官衰竭估计（SOFA）评分、白细胞计数、血红蛋白、血乳酸水平联合应用，可提升28天全因死亡率的预测性能（AUC=0.730）。
研究结论：当ACR水平低于2300时，较高的ACR值可能与更低的28天全因死亡率风险相关。此外，ACR对脓毒症不良预后具有一定的预测价值。