国际标准化比值与白蛋白比值和胃肠道出血重症患者死亡率之间的关联：一项基于MIMIC-IV数据库的回顾性研究

Association between international normalized ratio-to-albumin ratio and mortality in critically ill patients with gastrointestinal bleeding: a retrospective MIMIC-IV database study.

作者信息

Yang Xingyi, Ying Shasha, Lv Lihong, Ji Yishu, Ying Jiaqian, Ke Huyan

机构信息

Department of Gastroenterology Disease, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, 53 Beidong Road, Xianju County, Taizhou, 317300, Zhejiang, China.

Department of Nursing, Yunnan Technology and Business University, Kunming, China.

出版信息

BMC Gastroenterol. 2025 Aug 11;25(1):574. doi: 10.1186/s12876-025-04179-1.

DOI:10.1186/s12876-025-04179-1

PMID:40790158

Abstract

BACKGROUND

While the international normalized ratio-to-albumin ratio (PTAR) is an established independent prognostic indicator for various diseases, its predictive value for clinical outcomes in critically ill patients with acute gastrointestinal bleeding (GIB) has not been systematically evaluated. The present study aims to examine the correlation between PTAR levels and clinical outcomes in critically ill patients with GIB.

METHODS

To evaluate mortality risk, we conducted multivariable Cox proportional hazards regression analyses for both short-term and long-term survival, supplemented by Kaplan-Meier (K-M) curve analysis to compare survival trends among subgroups. The discriminatory performance of PTAR was further assessed using receiver operating characteristic (ROC) curve analysis, while restricted cubic splines (RCS) modeled nonlinear associations. Subgroup analyses were performed to examine potential interaction effects, and feature selection was executed via the Boruta algorithm. Finally, a prognostic nomogram integrating the key predictors was developed.

RESULTS

To explore the prognostic value of PTAR in GIB, this retrospective cohort study analyzed 1,557 patients. X-tile analysis determined an optimal cutoff value of 0.73 for PTAR in predicting 28-day mortality. Subsequent multivariate Cox regression analysis demonstrated that PTAR was an independent predictor of all-cause mortality (P < 0.001). This finding was corroborated by significant differences in KM survival curves (log-rank P < 0.001). Further assessment via ROC analysis indicated that PTAR exhibited moderate prognostic discrimination. Additionally, RCS analysis revealed a linear association between PTAR and mortality (P-nonlinear > 0.05). Subgroup analyses were also performed, yet no significant interactions were observed (all P-interaction values > 0.005). Finally, a nomogram developed using the Boruta algorithm, which incorporated PTAR as a key variable, achieved AUC values of 0.804 for 28-day mortality and 0.791 for 365-day mortality, respectively.

CONCLUSION

The PTAR is significantly associated with increased short- and long-term mortality risk in critically ill patients with GIB.

摘要

背景

虽然国际标准化比值与白蛋白比值（PTAR）是多种疾病公认的独立预后指标，但其对急性胃肠道出血（GIB）危重症患者临床结局的预测价值尚未得到系统评估。本研究旨在探讨PTAR水平与GIB危重症患者临床结局之间的相关性。

方法

为评估死亡风险，我们对短期和长期生存进行了多变量Cox比例风险回归分析，并辅以Kaplan-Meier（K-M）曲线分析以比较亚组间的生存趋势。使用受试者工作特征（ROC）曲线分析进一步评估PTAR的鉴别性能，同时采用限制立方样条（RCS）对非线性关联进行建模。进行亚组分析以检查潜在的交互作用，并通过Boruta算法进行特征选择。最后，开发了一个整合关键预测因子的预后列线图。

结果

为探讨PTAR在GIB中的预后价值，这项回顾性队列研究分析了1557例患者。X-tile分析确定PTAR预测28天死亡率的最佳临界值为0.73。随后的多变量Cox回归分析表明，PTAR是全因死亡率的独立预测因子（P < 0.001）。K-M生存曲线的显著差异证实了这一发现（对数秩P < 0.001）。通过ROC分析进一步评估表明，PTAR具有中等的预后鉴别能力。此外，RCS分析显示PTAR与死亡率之间存在线性关联（P-非线性 > 0.05）。还进行了亚组分析，但未观察到显著的交互作用（所有P-交互值 > 0.005）。最后，使用Boruta算法开发的列线图将PTAR作为关键变量纳入，28天死亡率的AUC值为0.804，365天死亡率的AUC值为0.791。