Figure 1
Flow diagram. It presented the inclusion and exclusion of the study participants.
Table 1
Baseline characteristics of MIMIC-IV participants according to tertiles of albumin-bilirubin score.
| CHARACTERISTICS | OVERALL (n = 4239) | T1 (n = 1413) | T2 (n = 1413) | T3 (n = 1413) | p VALUE |
|---|---|---|---|---|---|
| age (years), (mean (SD)) | 71.79 (14.46) | 71.95 (14.61) | 72.12 (14.38) | 71.31 (14.39) | 0.291 |
| male, n (%) | 2416 (57.0) | 793 (56.1) | 794 (56.2) | 829 (58.7) | 0.297 |
| BMI (kg/m2), (mean (SD)) | 28.88 (6.73) | 29.10 (6.79) | 29.08 (6.71) | 28.47 (6.67) | 0.019 |
| diabetes, n (%) | 1723 (40.6) | 593 (42.0) | 592 (41.9) | 538 (38.1) | 0.055 |
| hypertension, n (%) | 3203 (75.6) | 1139 (80.6) | 1082 (76.6) | 982 (69.5) | <0.001 |
| COPD, n (%) | 854 (20.1) | 298 (21.1) | 295 (20.9) | 261 (18.5) | 0.156 |
| APS III (mean (SD)) | 57.84 (24.78) | 49.63 (20.70) | 55.91 (22.44) | 67.98 (27.15) | <0.001 |
| heart rate (/min), (mean (SD)) | 90.76 (21.50) | 88.02 (20.18) | 90.50 (21.74) | 93.77 (22.15) | <0.001 |
| resp rate (/min), (mean (SD)) | 20.99 (6.35) | 20.75 (6.28) | 20.96 (6.01) | 21.25 (6.74) | 0.114 |
| SpO2(%) (mean (SD)) | 96.20 (4.64) | 96.47 (4.00) | 96.13 (4.74) | 96.00 (5.11) | 0.022 |
| SBP (mmHg), (mean (SD)) | 121.59 (25.71) | 129.06 (26.57) | 121.49 (24.67) | 114.21 (23.64) | <0.001 |
| WBC (10^9/L), (mean (SD)) | 13.05 (10.33) | 12.43 (10.32) | 13.03 (11.85) | 13.70 (8.51) | 0.005 |
| hemoglobin(g/dL), (mean (SD)) | 10.86 (2.51) | 11.66 (2.45) | 10.88 (2.42) | 10.05 (2.39) | <0.001 |
| platelets(10^9/L), (mean (SD)) | 221.34 (114.61) | 231.52 (100.33) | 227.26 (116.59) | 205.24 (123.95) | <0.001 |
| RDW (%), (mean (SD)) | 15.78 (2.59) | 15.12 (2.29) | 15.66 (2.49) | 16.55 (2.75) | <0.001 |
| Neutrophils (10^9/L), (mean (SD)) | 10.46 (6.80) | 9.58 (5.98) | 10.23 (6.22) | 11.58 (7.88) | <0.001 |
| total protein (g/dL), (mean (SD)) | 5.70 (0.95) | 6.28 (0.76) | 5.78 (0.79) | 5.03 (0.87) | <0.001 |
| Albumin (g/dL), (mean (SD)) | 3.27 (0.62) | 3.87 (0.35) | 3.31 (0.28) | 2.63 (0.44) | <0.001 |
| ALT (U/L), (mean (SD)) | 110.45 (439.79) | 69.45 (262.97) | 117.99 (457.70) | 143.90 (546.82) | <0.001 |
| AST (U/L), (mean (SD)) | 167.62 (733.63) | 104.91 (355.38) | 167.62 (701.40) | 230.32 (994.61) | <0.001 |
| ALP (U/L), (mean (SD)) | 119.49 (115.74) | 100.52 (98.85) | 109.81 (77.73) | 148.15 (152.05) | <0.001 |
| total bilirubin(mg/dl), (mean (SD)) | 1.25 (2.44) | 0.66 (1.25) | 0.95 (1.02) | 2.15 (3.74) | <0.001 |
| BUN (mg/dl), (mean (SD)) | 38.41 (27.84) | 36.89 (27.56) | 38.50 (27.04) | 39.85 (28.83) | 0.018 |
| Creatinine (mg/dl), (mean (SD)) | 1.99 (1.90) | 2.01 (2.06) | 2.01 (1.95) | 1.95 (1.69) | 0.625 |
| Drugs, n (%) | 1726 (40.7) | 404 (28.6) | 577 (40.8) | 745 (52.7) | <0.001 |
| CRRT, n (%) | 333 (7.9) | 91 (6.4) | 106 (7.5) | 136 (9.6) | 0.006 |
| Ventilation, n (%) | 1716 (40.5) | 497 (35.2) | 550 (38.9) | 669 (47.3) | <0.001 |
| Mortality, n (%) | 1831 (43.2) | 465 (32.9) | 589 (41.7) | 777 (55.0) | <0.001 |
[i] BMI, body mass index; COPD, chronic obstructive pulmonary disease; SpO2, saturation of peripheral oxygen; SBP, systolic blood pressure; MCH, mean corpuscular hemoglobin; MCV, mean corpuscular volume; MCHC, mean corpuscular hemoglobin concentration; RDW, red cell distribution width; WBC, white blood cell count; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; BUN, blood urea nitrogen; Drugs, administration of inotropes or vasopressors; CRRT, continuous renal replacement therapy; drugs, inotropes or vasopressors.
Figure 2
Kaplan-Meier survival curve and restricted cubic spline. Cumulative incidence of all-cause mortality according to ALBI tertiles (A) and Cubic spline model of the association between ALBI and risk of all-cause mortality in all patients adjusted with age, gender, WBC, hemoglobin, albumin, BUN, creatinine, inotropes or vasopressors, CRRT, mechanical ventilation and APS III (B).
Table 2
Cox models for the association between albumin-bilirubin score and all-cause mortality.
| ALBI | CASE/TOTAL | MODEL 0 | MODEL 1 | MODEL 2 | MODEL 3 |
|---|---|---|---|---|---|
| TERTILES | HAZARD RATIO | ||||
| T1 | 1413/4239 | reference | reference | reference | reference |
| T2 | 1413/4239 | 1.40(1.20, 1.50) | 1.13(0.98, 1.30) | 1.11(0.97, 1.28) | 1.09(0.95, 1.26) |
| T3 | 1413/4239 | 2.10(1.80, 2.30) | 1.43(1.18, 1.73) | 1.38(1.14, 1.67) | 1.20(0.99, 1.46) |
| p for trend | <0.001 | <0.001 | <0.001 | 0.059 | |
| Per tertiles increase | 1.40(1.40, 1.50) | 1.20(1.09, 1.32) | 1.18(1.07, 1.29) | 1.10(1.00, 1.21) | |
| Per unit increase | 1.80(1.60, 1.90) | 1.88(1.57, 2.30) | 1.83(1.53, 2.20) | 1.36(1.14, 1.63) | |
[i] Model 0: albumin-bilirubin score without adjust; Model 1: age, gender, WBC, hemoglobin, albumin, BUN and creatinine were adjusted; Model 2: the variables in model 1 plus inotropes or vasopressors, CRRT and mechanical ventilation were adjusted; Model 3: the variables in model 2 plus APS III were adjusted.
Figure 3
Subgroup analysis. Hazard ratios and error bars delineating 95% confidence intervals from Model 3 by subgroups (A) and the trends in the association between ALBI and the hazard ratio for all-cause mortality in subgroups defined by the use of inotropes or vasopressors (B).
Figure 4
Interaction restricted cubic spline. The trend of the association between ALBI and the hazard ratio (HR) for all-cause mortality with increasing age (A) and the trend of the association between ALBI and the hazard ratio (HR) for all-cause mortality with increasing creatinine (B).
Table 3
Modified Poisson regression models for the association between albumin-bilirubin score and all-cause mortality.
| ALBI | CASE/TOTAL | MODEL 0 | MODEL 1 | MODEL 2 | MODEL 3 |
|---|---|---|---|---|---|
| TERTILES | RISK RATIO | ||||
| T1 | 1413/4239 | reference | reference | reference | reference |
| T2 | 1413/4239 | 1.27(1.15, 1.40) | 1.13(1.02, 1.26) | 1.12(1.01, 1.24) | 1.09(0.99, 1.21) |
| T3 | 1413/4239 | 1.67(1.53, 1.83) | 1.33(1.16, 1.53) | 1.30(1.13, 1.49) | 1.17(1.02, 1.34) |
| p for trend | <0.001 | <0.001 | <0.001 | 0.022 | |
| Per tertiles increase | 1.30(1.24, 1.35) | 1.15(1.08, 1.24) | 1.14(1.06, 1.22) | 1.08(1.01, 1.16) | |
| Per unit increase | 1.45(1.37, 1.52) | 1.53(1.35, 1.73) | 1.51(1.33, 1.71) | 1.24(1.10, 1.40) | |
[i] Model 0: albumin-bilirubin score without adjust; Model 1: age, gender, WBC, hemoglobin, albumin, BUN and creatinine were adjusted; Model 2: the variables in model 1 plus inotropes or vasopressors, CRRT and mechanical ventilation were adjusted; Model 3: the variables in model 2 plus APS III were adjusted.