血清尿素氮/白蛋白比值对重症急性胰腺炎住院患者全因死亡率的风险预测
Risk prediction of all-cause mortality in hospitalized patients with severe acute pancreatitis by serum urea nitrogen/albumin ratio.
作者信息
Qiu Huisi, Fu Yongshuai, Lv Ziwen, Zhu Xingyu, Gu Junhui, Gao Zhuo, Liu Dong
机构信息
Department of Qingyuan People, s Hospital, Guangzhuo, China.
Department of Guangzhou Medical University, Beijing, China.
出版信息
PLoS One. 2025 Sep 19;20(9):e0326543. doi: 10.1371/journal.pone.0326543. eCollection 2025.
BACKGROUND
Classification of risk levels in patients with acute pancreatitis remains a difficult task. Although some biomarkers have emerged to predict the prognosis of patients with acute pancreatitis, they have not been widely used in clinical practice for several reasons. This study aimed to investigate the correlation between the serum urea nitrogen-to-albumin ratio (BAR) and the mortality risk in ICU patients with acute pancreatitis.
METHOD
This was a retrospective study. Data were collected from the Medical Information Mart for Intensive Care IV (MIMIC IV 2.0). The primary outcome was in-hospital mortality in the patients with severe acute pancreatitis. In this study, multivariate logistic proportional regression analysis and restricted cubic spline regression were used to evaluate the association between serum urea nitrogen/albumin ratio and in-hospital mortality in patients with severe acute pancreatitis. In the sensitivity analysis, the Boruta and random forest algorithms were used to determine the feature importance of the serum urea nitrogen to albumin ratio, and subgroup analysis was used to explore the robustness of the results.
RESULT
726 patients were included in this study. The in-hospital mortality rate was 11.85%. Multivariate logistic regression analysis revealed that BAR was independently associated with an increased risk of in-hospital mortality (odds ratio [HR], 1.081 [95% confidence interval [CI], 1.062-1.101]; P < 0.001). The restricted cubic spline regression model revealed that the risk of in-hospital mortality increased linearly with increasing BAR. Sensitivity analysis indicated that the results were stable. Additionally, the machine learning results suggested that the serum urea nitrogen to albumin ratio is an important feature for the outcomes of severe acute pancreatitis.
CONCLUSION
A high serum urea nitrogen to albumin ratio was significantly associated with in-hospital mortality in patients with severe acute pancreatitis.
背景
急性胰腺炎患者风险水平的分类仍然是一项艰巨的任务。尽管已经出现了一些生物标志物来预测急性胰腺炎患者的预后，但由于多种原因，它们尚未在临床实践中广泛应用。本研究旨在探讨血清尿素氮与白蛋白比值（BAR）与急性胰腺炎重症监护病房（ICU）患者死亡风险之间的相关性。
方法
这是一项回顾性研究。数据收集自重症监护医学信息数据库IV（MIMIC IV 2.0）。主要结局是重症急性胰腺炎患者的院内死亡率。在本研究中，采用多因素逻辑比例回归分析和限制性立方样条回归来评估血清尿素氮/白蛋白比值与重症急性胰腺炎患者院内死亡率之间的关联。在敏感性分析中，使用Boruta和随机森林算法确定血清尿素氮与白蛋白比值的特征重要性，并采用亚组分析来探索结果的稳健性。
结果
本研究纳入726例患者。院内死亡率为11.85%。多因素逻辑回归分析显示，BAR与院内死亡风险增加独立相关（风险比[HR]，1.081[95%置信区间[CI]，1.062 - 1.101]；P < 0.001）。限制性立方样条回归模型显示，院内死亡风险随BAR升高呈线性增加。敏感性分析表明结果稳定。此外，机器学习结果提示血清尿素氮与白蛋白比值是重症急性胰腺炎结局的一个重要特征。
结论
血清尿素氮与白蛋白比值升高与重症急性胰腺炎患者的院内死亡率显著相关。
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