Yang XingYi, Zhang Min, Lv LiHong, Chen XuYong, Li ZhenMei
Department of Gastroenterology Disease, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, Xianju, Taizhou, Zhejiang, China.
PLoS One. 2025 May 22;20(5):e0323330. doi: 10.1371/journal.pone.0323330. eCollection 2025.
The Total Bilirubin-to-Albumin Ratio (TBAR) is widely recognized and applied as a biomarker in the prognostic evaluation of various diseases. However, its role in predicting survival outcomes in patients with acute pancreatitis (AP) remains underexplored. This study aims to investigate the association between TBAR levels and mortality rates in AP patients, thereby providing a novel prognostic indicator for clinical use.
This study investigates the association between TBAR and mortality in AP patients. We stratified patient data using X-tile software to analyze intergroup differences. Risk factors significantly associated with mortality were identified through univariate and multivariate regression analyses. Kaplan-Meier (KM) analysis evaluated TBAR's impact on survival, while Receiver Operating Characteristic (ROC) analysis assessed its predictive accuracy, sensitivity, and Area Under the Curve (AUC) for mortality. To ensure robustness, we used Restricted Cubic Spline (RCS) modeling to explore non-linear relationships and performed subgroup analyses to verify the consistency of the TBAR mortality association across patient subgroups.
This study included 477 patients. Using X-tile software, we set the optimal TBAR cutoff at 1.33 based on 28-day mortality. Patients were categorized into high-risk (TBAR ≥ 1.33) and low-risk (TBAR < 1.33) groups. Elevated TBAR significantly correlated with increased mortality at multiple time points (7, 14, 21, 28, 90, and 365 days; P < 0.05). KM analysis confirmed lower survival rates in the high-risk group at all time points (P < 0.05). ROC analysis showed TBAR's predictive accuracy for mortality was comparable to the SOFA score and superior to other indicators. RCS modeling revealed a linear TBAR mortality relationship. Subgroup analyses showed no significant interactions between TBAR and most subgroups.
The TBAR is strongly correlated with short-term and long-term mortality in patients with acute pancreatitis.
总胆红素与白蛋白比值（TBAR）作为一种生物标志物在多种疾病的预后评估中已得到广泛认可和应用。然而，其在预测急性胰腺炎（AP）患者生存结局方面的作用仍未得到充分研究。本研究旨在探讨AP患者TBAR水平与死亡率之间的关联，从而为临床提供一种新的预后指标。
本研究调查了AP患者中TBAR与死亡率之间的关联。我们使用X-tile软件对患者数据进行分层，以分析组间差异。通过单因素和多因素回归分析确定与死亡率显著相关的危险因素。Kaplan-Meier（KM）分析评估TBAR对生存的影响，而受试者工作特征（ROC）分析评估其对死亡率的预测准确性、敏感性和曲线下面积（AUC）。为确保稳健性，我们使用限制立方样条（RCS）建模来探索非线性关系，并进行亚组分析以验证TBAR与死亡率关联在各患者亚组中的一致性。
本研究纳入了477例患者。使用X-tile软件，基于28天死亡率将最佳TBAR临界值设定为1.33。患者被分为高风险（TBAR≥1.33）和低风险（TBAR＜1.33）组。TBAR升高在多个时间点（7、14、21、28、90和365天；P＜0.05）与死亡率增加显著相关。KM分析证实高风险组在所有时间点的生存率均较低（P＜0.05）。ROC分析表明，TBAR对死亡率的预测准确性与序贯器官衰竭评估（SOFA）评分相当，且优于其他指标。RCS建模显示TBAR与死亡率呈线性关系。亚组分析表明，TBAR与大多数亚组之间无显著交互作用。
TBAR与急性胰腺炎患者的短期和长期死亡率密切相关。
