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Associations between albumin-bilirubin score and all-cause mortality among individuals with acute myocardial infarction: A cohort study based upon MIMIC-IV.
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3 authors.
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Abstract
ObjectiveThe albumin-bilirubin (ALBI) score is a validated prognostic tool in liver diseases. Nevertheless, its role in acute myocardial infarction (AMI) remains underexplored. This research sought to explore associations between ALBI score and all-cause mortality (ACM) among individuals with AMI.MethodsThis retrospective cohort study used MIMIC-IV v3.1 data. Patients were classified into four groups by ALBI score quartiles. The primary outcomes encompassed ACM within 30 and 365 days. Kaplan-Meier (KM) curves were used to compare differences in survival outcomes among the four groups. Cox proportional hazards models were used to investigate associations between ALBI scores and ACM. Moreover, restricted cubic splines (RCS) were employed to investigate dose-response relationships between ALBI score and ACM at different time points among individuals with AMI. We calculated the area under the ROC curve (AUC), integrated discrimination improvement (IDI), and net reclassification improvement (NRI) to evaluate the incremental predictive value of adding ALBI to the SOFA, SAPSII, and APSIII scoring systems.ResultsIn total, 2,105 patients were included, 1,294(61.47%) were men. KM curves showed lower survival in highest vs lowest ALBI quartile((log-rank P<0.05) Cox proportional hazards regression analysis indicated that in the extensively adjusted model, when ALBI was analyzed as a continuous variable, each one-unit elevation correlated with a 47.7% rise in ACM within 30 days(adjusted HR=1.477, 95%CI:1.249-1.746, P<0.001) and a 52.2% rise in ACM within 365 days (adjusted HR=1.522, 95%CI:1.331-1.741, P<0.001).When ALBI was examined as a categorical variable, compared to the Q1 group, the risks of ACM in the Q4 group were 1.873 times higher within 30 days and 1.784 times higher within 365 days. RCS analyses indicated a positive linear association between ALBI score and ACM within 14, 30, 90, and 365 days. In addition, the inclusion of ALBI in the SOFA, SAPSII, and APSIII scoring systems enhanced the predictive accuracy of the models.ConclusionsHigh ALBI scores may be associated with an increased risk of ACM in critically ill patients with AMI admitted to ICUs, and ALBI may provide incremental prognostic information independent of conventional critical illness scoring systems.
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