ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1540647
Association Between the Serum Albumin-to-Creatinine Ratio and 28-day All-cause Mortality in Sepsis: A Retrospective Cohort Study
Provisionally accepted
- 1The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- 2The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Objective:This study aimed to investigate the association between the serum albumin-to-creatinine ratio (ACR) and the prognosis of sepsis.Methods: Extracted 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.Results: After screening and matching, a total of 1418 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 2300, there was a negative association between ACR and mortality. However, no significant association was observed when ACR exceeded 2300. 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).Conclusions: A higher ACR value may associated with a lower 28-day all-cause mortality risk when ACR value was less than 2300.Moreover, ACR had some predictive power for adverse outcomes in sepsis.
Keywords: Sepsis, Albumin (ALB), Creatinine (Cr), Mortality, prognosis
Received: 06 Dec 2024; Accepted: 05 Aug 2025.
Copyright: © 2025 Wu, Yu, Li, Wu, Jian, Zheng, Deng and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jian Li, The Second Affiliated Hospital, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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