The difference in hematocrit and albumin levels and the risk of sepsis for patients with acute pancreatitis: a retrospective cohort study based on the MIMIC-IV database

TL;DR

This study found that higher hematocrit-albumin (HCT-ALB) values are linked to increased sepsis risk in patients with acute pancreatitis, suggesting it could help identify those at risk.

Contribution

The novelty is investigating the HCT-ALB score as a predictor of sepsis risk specifically in acute pancreatitis patients.

Findings

HCT-ALB ≥ 7.6 was associated with increased sepsis risk in acute pancreatitis patients (OR 1.82).

The HCT-ALB AUC (0.599) outperformed the BISAP score (AUC 0.558) in predicting sepsis risk.

HCT-ALB was linked to sepsis risk in male patients with acute kidney injury and low SOFA scores.

Abstract

Acute pancreatitis (AP) is a major cause of gastrointestinal hospitalization, with an annual global incidence of 3.07%. Severe AP develops in up to 20% of cases, with sepsis occurring in 40–70% of such cases, leading to higher mortality. The early detection of sepsis is crucial. Hematocrit (HCT) and albumin (ALB) levels are individually linked to sepsis. Their combined measure, HCT-ALB, indicates blood and nutritional health. HCT-ALB can predict sepsis and infection outcomes; however, its effectiveness in treating AP-related sepsis has not been investigated.

This study aimed to examine the association between HCT-ALB values and sepsis risk in patients with AP.

This retrospective cohort study used Medical Information Market for Intensive Care IV database data. The primary outcome was the risk of sepsis in patients with AP. The HCT-ALB value refers to the difference between HCT and ALB levels, which we categorized into three groups according to quantiles: < 0.5, 0.5–7.6, and ≥ 7.6. Logistic regression models were used to assess the association between HCT-ALB values and sepsis. The predictive value of HCT-ALB was assessed using a receiver operating characteristic curve. Subgroup analyses were conducted for different subgroups.

Among 565 patients with AP, 163 developed sepsis. In the multivariable model, HCT-ALB ≥ 7.60 was associated with sepsis risk for patients with AP [odds ratio (OR) 1.82, 95% confidence interval (CI) 1.06–3.14]. The area under the curve (AUC) value of HCT-ALB in predicting sepsis risk among patients with AP was 0.599 (95% CI 0.544–0.654), which was higher than that of the bedside index for severity in acute pancreatitis score (AUC 0.558, 95% CI 0.509–0.607). Subgroup analysis showed that HCT-ALB was only related to sepsis risk in male patients with acute kidney injury and Sequential Organ Failure Assessment in < 2 subgroups.

HCT-ALB values ≥ 7.6 were associated with increased sepsis risk in patients with AP. HCTALB may contribute to identifying the risk of sepsis in patients with AP.

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