Association of albumin trajectories and cumulative exposure with in-hospital mortality in acute pancreatitis: a retrospective cohort study

作者：Yaoyu Zou, Maobin Kuang, Shixuan Xiong, Xin Xu, Xue-Yang Li, Ling Ding, Cong He, Nianshuang Li, Huajing Ke, Xin Huang, Yupeng Lei, Huifang Xiong, Wenhua He, Lingyu Luo, Xia Liang, Nonghua Lü, Jianhua Wan, Yin Zhu · 发表于：International Journal of Surgery · 年份：2025 · DOI：10.1097/js9.0000000000003354 · 被引用次数：10 · 研究领域：Pancreatitis Pathology and Treatment、Pancreatic and Hepatic Oncology Research、IgG4-Related and Inflammatory Diseases

BACKGROUND: Hypoalbuminemia is common in acute pancreatitis (AP) and associated with poor outcomes, but its cumulative and dynamic impacts are not well characterized. METHODS: This study included 3,214 AP patients (2005-2023). Cumulative albumin exposure (CumALB) was calculated over the first 7 days using the trapezoidal method. Latent class mixed modeling (LCMM) identified distinct albumin trajectories. Multivariable logistic regression and restricted cubic splines (RCS) assessed associations between CumALB and in-hospital mortality. Kaplan-Meier curves compared survival across trajectories. A simplified nomogram was developed using predictors selected via Boruta and LASSO algorithms, with performance assessed by AUC, calibration, and decision curves. Validation was conducted in three cohorts: the MIMIC-IV database ( n = 514), the eICU-CRD database ( n = 211), and the local cohort from 2024 ( n = 880). RESULTS: Patients in the lowest CumALB tertile had significantly higher mortality (11.0%) than those in the highest tertile (1.3%, P < 0.001). Each 1-SD increase in CumALB reduced mortality risk by 42% (adjusted OR = 0.58, 95% CI: 0.44-0.76, P < 0.001), with RCS confirming a linear inverse relationship. CumALB outperformed single-day albumin in mortality prediction. LCMM identified four trajectories; low-stable (LS-T1) had highest mortality (17.7%), whereas low-increasing (LI-T4) had lower mortality (8.6%). Compared with LS-T1, high-stable (HS-T2) and LI-T4 groups had reduced ...