Glucose-to-albumin ratio and mortality in ICU patients with acute pancreatitis.

Objectives: Acute pancreatitis (AP) carries a high mortality risk in ICU patients. The glucose-to-albumin ratio (GAR), reflecting metabolic stress and albumin status, may serve as a simple prognostic marker. This study evaluated the association between GAR and mortality in ICU patients with AP. Methods: Data from 754 ICU patients with AP from the MIMIC-IV database were analyzed. Patients were divided into quartiles based on GAR. Multivariable Cox regression, Kaplan-Meier survival analysis, Boruta algorithm, and machine learning models were used to assess the relationship between GAR and 30-day and 90-day mortality. Results: Elevated GAR was independently associated with increased mortality risk. For 30-day mortality, GAR had the highest AUC (0.69) compared to albumin, SOFA, and glucose. Patients in the highest GAR quartile had a 10.2-fold increased risk of 30-day mortality (p<0.001). The Boruta algorithm identified GAR as an important predictor, and LightGBM showed the best performance (AUC=0.83). Conclusions: GAR was independently associated with 30-day and 90-day mortality in ICU patients with AP. As a simple and readily available biomarker, GAR may help improve early mortality risk stratification in this critically ill population.