ORIGINAL RESEARCH article
Front. Med.
Sec. Pulmonary Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1680205
Association between the platelet-to-albumin ratio and 28-day all-cause mortality in critically ill patients with Pulmonary embolism: a retrospective cohort study and predictive model establishment based on machine learning
Provisionally accepted
- First Affiliated Hospital of Jilin University, Changchun, China
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Background Pulmonary embolism (PE) is a serious condition that is frequently encountered in clinical practice. It has been demonstrated that the body's physiological responses to platelet activation can lead to significant complications, including pulmonary hypertension, bronchoconstriction, and right heart failure. Albumin is recognized as a composite indicator of acute-phase reactant proteins, which have osmotic and anti-inflammatory properties, as well as nutrient and metabolic imbalance. Albumin demonstrates independent prognostic value in a variety of diseases. The platelet-to-albumin ratio (PAR) has emerged as a reliable predictor of mortality and complications based on systemic inflammation in a number of diseases. However, studies on the relationship between PAR and adverse outcomes in critically ill patients with pulmonary embolism are limited. Thus, this study aimed to investigate whether PAR could be a useful indicator for assessing pulmonary embolism outcomes. Methods The clinical data of 1163 patients with critical pulmonary embolisms were extracted from the MIMIC-IV (version 2.2) database. The study population was categorized into four groups according to PAR quartiles. The primary regression was 28-day ICU mortality, while the secondary regressions were 7-d and 14-d ICU mortality. Restricted cubic splines, Cox proportional hazards regression, and Kaplan-Meier curves were used to explore the relationship between PAR and adverse outcomes. We assessed the predictive power of PAR using the Boruta algorithm and built predictive models using machine learning algorithms. Results Data from 1163 patients diagnosed with pulmonary embolism were analyzed. Lower PAR was significantly associated with an increased risk of 7-d (p < 0.001), 14-d (p < 0.001), and 28-d (p < 0.005) ICU mortality compared with higher PAR. The restricted cubic spline curve revealed an "L-shaped" relationship between PAR and survival, suggesting that an increase in PAR is linked to a reduced risk of adverse events.
Keywords: Pulmonary Embolism, platelet-to-albumin ratio, Critical Illness, Boruta algorithm, machine learning
Received: 05 Aug 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 Chang, Zhu, Liu and Zheng. 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: Haibo Liu, hbliu@jlu.edu.cn
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