Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 18:12:1562091.
doi: 10.3389/fnut.2025.1562091. eCollection 2025.

Nonlinear relationship between fibrinogen-to-albumin ratio and mortality in critically ill patients with sepsis: a retrospective cohort study

Daishan Jiang #  1 , Xiaoyu Yuan #  1 , Yanbo Shen  1 , Tingting Bian  2
Affiliations

Nonlinear relationship between fibrinogen-to-albumin ratio and mortality in critically ill patients with sepsis: a retrospective cohort study

Daishan Jiang et al. Front Nutr. .

Abstract

Background: The fibrinogen-albumin ratio (FAR) is recognized as a prognostic biomarker in several diseases, but its role in sepsis remains controversial. To elucidate the relationship between FAR and mortality risk in a large cohort of patients with sepsis.

Methods: In this retrospective cohort study, we analyzed clinical data from the Medical Information Mart for Intensive Care IV Database (version 2.2) to investigate the mortality of sepsis patients. We employed restricted cubic spline curves and Cox regression models to evaluate the effect of FAR on mortality and conducted subgroup analyses to verify the consistency of our primary findings.

Results: In our analysis of 4,615 sepsis patients, we observed that mortality risk initially decreased with increasing FAR values, reaching a minimum at approximately 94.5*10-3, before rising again. Cox regression analysis revealed differing hazard ratios (HRs) for FAR quartiles relative to the second quartile (Q2). At 28 days, adjusted HRs were 1.23 (95% CI: 1.03-1.46) for Q1, 1.14 (0.96-1.36) for Q3, and 1.11 (0.93-1.33) for Q4. By 90 days, these HRs adjusted to 1.25 (1.07-1.46) for Q1, 1.21 (1.04-1.41) for Q3, and 1.21 (1.03-1.42) for Q4. This pattern persisted at 1-year mortality, with HRs of 1.16 (1.00-1.33) for Q1, 1.22 (1.06-1.39) for Q3, and 1.24 (1.07-1.43) for Q4.

Conclusion: FAR exhibited a nonlinear, U-shaped association with mortality risk at 28 days, 90 days, and 1 year in patients with sepsis. These findings suggest that FAR may serve as a practical prognostic biomarker to support early risk stratification and clinical decision-making in sepsis care.

Keywords: MIMIC database; biomarkers; fibrinogen-to-albumin ratio; mortality; sepsis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart showing patient screening.
Figure 2
Figure 2
The restricted cubic spline for the association between FAR and predicted probability of mortality.
Figure 3
Figure 3
Kaplan–Meier survival curve for mortality according to FAR.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. (2016) 315:801–10. doi: 10.1001/jama.2016.0287, PMID: - DOI - PMC - PubMed
    1. Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. (2021) 47:1181–247. doi: 10.1007/s00134-021-06506-y, PMID: - DOI - PMC - PubMed
    1. Jiang D, Bian T, Shen Y, Huang Z. Association between admission systemic immune-inflammation index and mortality in critically ill patients with sepsis: a retrospective cohort study based on MIMIC-IV database. Clin Exp Med. (2023) 23:1029. doi: 10.1007/s10238-023-01029-w, PMID: - DOI - PMC - PubMed
    1. Vilar R, Fish RJ, Casini A, Neerman-Arbez M. Fibrin(ogen) in human disease: both friend and foe. Haematologica. (2020) 105:284–96. doi: 10.3324/haematol.2019.236901, PMID: - DOI - PMC - PubMed
    1. May JE, Wolberg AS, Lim MY. Disorders of fibrinogen and fibrinolysis. Hematol Oncol Clin North Am. (2021) 35:1197–217. doi: 10.1016/j.hoc.2021.07.011, PMID: - DOI - PMC - PubMed

LinkOut - more resources