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

Jin, Mingjie; Wu, Yanmin; Ye, Bin

doi:10.1590/1516-3180.2024.0401.14042025

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ORIGINAL ARTICLE • Sao Paulo Med. J. 143 (6) • 2025 • https://doi.org/10.1590/1516-3180.2024.0401.14042025 linkcopy

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

Authorship SCIMAGO INSTITUTIONS RANKINGS

BACKGROUND: 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.

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

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

KEYWORDS (MeSH terms):
Hematocrit; Albumin; Sepsis; Pancreatitis; Mortality

Variables		Total (n = 565)	Groups		Statistics	P value
Variables		Total (n = 565)	Non-sepsis (n = 402)	Sepsis (n = 163)	Statistics	P value
Age, years; mean ± SD		57.8 ± 17.61	58.56 ± 18.10	55.91 ± 16.26	t = 1.62	0.105
Sex, n (%)
	Women	246 (43.54)	173 (43.03)	73 (44.79)	χ² = 0.145	0.704
	Men	319 (56.46)	229 (56.97)	90 (55.21)	χ² = 0.145	0.704
Ethnicity, n (%)
	African American	55 (9.73)	41 (10.2)	14 (8.59)	χ² = 2.358	0.501
	European	348 (61.59)	253 (62.94)	95 (58.28)	χ² = 2.358	0.501
	Other	67 (11.86)	44 (10.95)	23 (14.11)
	Ethnicity not stated	95 (16.81)	64 (15.92)	31 (19.02)
Marital status, n (%)
	Married	223 (39.47)	161 (40.05)	62 (38.04)	χ² = 3.381	0.496
	Never married	178 (31.5)	120 (29.85)	58 (35.58)
	Divorced	43 (7.61)	32 (7.96)	11 (6.75)
	Widowed	53 (9.38)	42 (10.45)	11 (6.75)
	Unknown	68 (12.04)	47 (11.69)	21 (12.88)
HCT, %; mean ± SD		34.06 ± 6.91	33.96 ± 6.4	34.31 ± 8.04	t = −0.48	0.628
ALB, g/L; mean ± SD		29.78 ± 6.23	30.43 ± 6.16	28.17 ± 6.14	t = 3.97	< 0.001
HCT-ALB, M (Q₁, Q₃)		4.00 (−1, 9.6)	3.20 (−1.3, 8.5)	6.3 (0.4, 13.1)	Z = 3.69	< 0.001
HCT-ALB, n (%)
	< 0.50	184 (32.57)	143 (35.57)	41 (25.15)	χ² = 14.115	< 0.001
	0.50−7.60	193 (34.16)	144 (35.82)	49 (30.06)
	≥ 7.60	188 (33.27)	115 (28.61)	73 (44.79)
MBP, mmHg; mean ± SD		91.71 ± 19.17	93.25 ± 18.57	87.9 ± 20.11	t = 3.03	0.003
Respiratory rate, mean ± SD		21.66 ± 6.67	21.6 ± 6.65	21.8 ± 6.75	t = −0.33	0.739
Temperature, °C; mean ± SD		36.84 ± 1	36.79 ± 0.96	36.97 ± 1.09	t = −1.83	0.069
Creatinine, mg/dL; M (Q₁, Q₃)		1.1 (0.7, 2)	1 (0.7, 1.6)	1.50 (0.9, 2.8)	Z = 4.417	< 0.001
Hemoglobin, g/dL; mean ± SD		11.28 ± 2.33	11.27 ± 2.2	11.31 ± 2.64	t = −0.18	0.854
BUN, mg/dL; M (Q₁, Q₃)		20 (12, 37)	17.5 (11, 35)	26 (17, 44)	Z = 4.797	< 0.001
RDW, %; mean ± SD		15.21 ± 2.18	15.14 ± 1.91	15.38 ± 2.73	t = −0.99	0.323
Platelet, K/uL; M (Q₁, Q₃)		182 (125, 265)	183.5 (128, 267)	181 (124, 248)	Z = −0.888	0.375
Bilirubin, mg/dL; M (Q₁, Q₃)		1.1 (0.6, 3)	1 (0.6, 3)	1.1 (0.6, 2.9)	Z = 0.726	0.468
Bicarbonate, mEq/L; mean ± SD		20.65 ± 5.66	21.08 ± 5.52	19.58 ± 5.88	t = 2.88	0.004
Sodium, mEq/L; mean ± SD		138.38 ± 5.91	138.3 ± 5.44	138.55 ± 6.93	t = −0.41	0.682
Potassium, mEq/L; mean ± SD		4.16 ± 0.91	4.12 ± 0.92	4.25 ± 0.88	t = −1.52	0.13
Chloride, mEq/L; mean ± SD		104.65 ± 7.33	104.31 ± 7.12	105.49 ± 7.78	t = −1.74	0.083
Phosphate, mg/dL; M (Q₁, Q₃)		3.3 (2.3, 4.2)	3.2 (2.2, 4)	3.6 (2.5, 4.9)	Z = 3.231	0.001
Glucose, mg/dL ; M (Q₁, Q₃)		124 (100, 174)	121 (99, 167)	137 (104, 194)	Z = 2.425	0.015
ALT, IU/L; M (Q₁, Q₃)		54 (25, 168)	54.5 (25, 168)	54 (26, 167)	Z = 0.109	0.913
AST, IU/L; M (Q₁, Q₃)		78 (38,187)	72.5 (35,182)	87 (46, 216)	Z = 2.115	0.034
SpO₂, %; mean ± SD		95.93 ± 4.58	96.01 ± 4.44	95.72 ± 4.93	t = 0.68	0.498
INR, M (Q₁, Q₃)		1.3 (1.1, 1.6)	1.3 (1.1, 1.6)	1.4 (1.2, 1.7)	Z = 2.295	0.022
PT, seconds; M (Q₁, Q₃)		14.4 (13, 17.3)	14.2 (13, 17)	14.9 (13.2, 17.9)	Z = 1.839	0.066
Lipase, n (%)
	< 208 U/L	158 (27.96)	108 (26.87)	50 (30.67)	χ² = 0.863	0.65
	≥ 208 U/L	217 (38.41)	156 (38.81)	61 (37.42)
	Unknown	190 (33.63)	138 (34.33)	52 (31.9)
SOFA, M (Q₁, Q₃)		2 (0, 5)	2 (0, 4)	4 (1, 7)	Z = 6.027	< 0.001
BISAP, M (Q₁, Q₃)		2 (1, 3)	2 (1, 3)	2 (1, 3)	Z = 2.28	0.023
GCS, mean ± SD		14.53 ± 1.58	14.56 ± 1.43	14.45 ± 1.91	t = 0.69	0.491
CCI, M (Q₁, Q₃)		2 (1, 3)	2 (1, 3)	2 (1, 4)	Z = 0.188	0.851
Heart failure, yes; n (%)		83 (14.69)	58 (14.43)	25 (15.34)	χ₂ = 0.077	0.782
Hypertension, yes; n (%)		321 (56.81)	234 (58.21)	87 (53.37)	χ₂ = 1.105	0.293
Diabetes, yes; n (%)		170 (30.09)	127 (31.59)	43 (26.38)	χ₂ = 1.498	0.221
Renal failure, yes; n (%)		61 (10.8)	37 (9.2)	24 (14.72)	χ₂ = 3.669	0.055
Liver disease, yes; n (%)		124 (21.95)	86 (21.39)	38 (23.31)	χ₂ = 0.25	0.617
COPD, yes; n (%)		24 (4.25)	17 (4.23)	7 (4.29)	χ₂ = 0.001	0.972
AKI, yes; n (%)		278 (49.2)	164 (40.8)	114 (69.94)	χ₂ = 39.409	< 0.001
Antibiotics, yes; n (%)		348 (61.59)	230 (57.21)	118 (72.39)	χ₂ = 11.295	< 0.001
Mechanical ventilation use, yes; n (%)		443 (78.41)	293 (72.89)	150 (92.02)	χ₂ = 25.092	< 0.001
Vasopressor use, yes; n (%)		154 (27.26)	69 (17.16)	85 (52.15)	χ₂ = 71.584	< 0.001
RRT, yes; n (%)		49 (8.67)	24 (5.97)	25 (15.34)	χ₂ = 12.848	< 0.001
Enteral nutrition, yes; n (%)		30 (5.31)	15 (3.73)	15 (9.2)	χ₂ = 6.905	0.009

Variables	Univariate logistic regression model		Multivariate logistic regression model
Variables	OR (95% CI)	P value	OR (95% CI)	P value
HCT-ALB
< 0.5	Ref		Ref
0.5–7.6	1.19 (0.74–1.91)	0.48	1.31 (0.76–2.26)	0.337
≥ 7.6	2.21 (1.41–3.49)	< 0.001	1.82 (1.06–3.14)	0.03

Variables	Univariate logistic regression model				Multivariate logistic regression model
Variables	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value
Subgroup I: Sex	Male		Female		Male		Female
HCT-ALB
< 0.5	Ref		Ref		Ref		Ref
0.5–7.6	1.11 (0.55–2.21)	0.777	1.25 (0.65–2.42)	0.502	1.62 (0.67–3.9)	0.28	1.40 (0.62–3.18)	0.423
≥ 7.6	3.05 (1.64–5.66)	<0.001	1.43 (0.71–2.88)	0.313	3.43 (1.52–7.76)	0.003	1.13 (0.47–2.75)	0.78
Subgroup II: AKI	No		Yes		No		Yes
HCT-ALB
< 0.5	Ref		Ref		Ref		Ref
0.5–7.6	1.85 (0.85–4.05)	0.121	0.78 (0.42–1.48)	0.454	1.71 (0.68–4.33)	0.257	1.12 (0.54–2.32)	0.77
≥ 7.6	2.40 (1.08–5.33)	0.032	1.62 (0.89–2.94)	0.112	1.69 (0.63–4.53)	0.295	2.21 (1.08–4.53)	0.031
Subgroup III: SOFA	SOFA ≥2		SOFA <2		SOFA ≥2		SOFA <2
HCT-ALB
< 0.5	Ref		Ref		Ref		Ref
0.5–7.6	1.13 (0.63–2.04)	0.688	1.56 (0.65–3.78)	0.323	1.36 (0.68–2.72)	0.377	1.20 (0.4–3.6)	0.749
≥ 7.6	1.52 (0.87–2.64)	0.141	4.26 (1.81–10)	< 0.001	1.42 (0.74–2.74)	0.291	4.1(1.33–12.6)	0.014

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[T1FN1] Abbreviations: AKI, acute kidney injury; ALB, albumin; ALT, alanine aminotransferase; AST, aspartate aminotransferase; BISAP, bedside index for severity in acute pancreatitis; BUN, blood urea nitrogen; CCI, Charlson comorbidity index; COPD, chronic obstructive pulmonary disease; GCS, Glasgow Coma Scale; HCT, hematocrit; HCT-ALB, difference between HCT and ALB; INR, international normalized ratio; MBP, mean blood pressure; PT, prothrombin time; RDW, red cell distribution width; RRT, renal replacement therapy; SOFA, sequential organ failure assessment; SpO2, oxygen saturation.