Association between serum albumin to creatinine ratio and mortality risk in patients with acute-on-chronic liver failure.

Decreased Albumin-to-Creatinine Ratio (ACR) is associated with poor prognosis in a variety of diseases, and little is known about the relationship between ACR and acute-on-chronic liver failure (ACLF). The aim of this study was to investigate the relationship between ACR and short-term prognosis in patients with ACLF and to assess the role of ACR as a short-term poor prognosticator in these patients. Our retrospective data were collected from hospitalized ACLF patients. Receiver operating characteristic curve (ROC) and Kaplan-Meier survival analyses were used to assess the efficacy of prognostic assessment of ACR, and univariate and multivariate logistic regression were used to characterize the relationship between ACR and independent risk factors for short-term mortality, and subgroup analyses were used to obtain further reliable evidence. A total of 240 patients with ACLF were included in the study. The 28-day mortality rate was 25% (60/240). Receiver operating characteristic curve (ROC) analysis showed that the area under the curve (AUC) for ACR, albumin (ALB) and creatinine (Cr) were 0.797 (95% CI 0.730-0.861, p < 0.001), 0.672 (95% CI 0.601-0.743, P < 0.001), 0.759 (95% CI 0.688-0.829, P < 0.001), and the results of the Kaplan-Meier survival analysis similarly showed that the ACR level was significantly negatively associated with ACLF mortality (P < 0.0001). Univariate and multivariate logistic regression analyses showed that increased ACR was associated with lower mortality in patients (OR 0.10; 95% CI 0.02-0.35, P < 0.001), subgroup analyses led to the same conclusion. Low levels of ACR were significantly associated with patients in ACLF, and this study was the first to characterize the relationship between ACR and 28-day mortality in patients with ACLF, which will help clinicians accurately identify early disease progression.