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. 2025 Jul 14:2025:9930648.
doi: 10.1155/mi/9930648. eCollection 2025.

Association of Albumin-Bilirubin (ALBI) Grade With 28-Day All-Cause Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Analysis of the MIMIC-IV Database

Weixiao Chen  1 , Qingzhou Chen  1 , Zhiwei Tang  1 , Zhibo Li  1 , Weiyan Chen  1 , Xuming Xiong  1 , Deliang Wen  1 , Zhenhui Zhang  1   2
Affiliations

Association of Albumin-Bilirubin (ALBI) Grade With 28-Day All-Cause Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Analysis of the MIMIC-IV Database

Weixiao Chen et al. Mediators Inflamm. .

Abstract

The albumin-bilirubin (ALBI) grade, a validated prognostic tool in cancers such as hepatocellular carcinoma, has not been evaluated in acute respiratory distress syndrome (ARDS). This retrospective cohort study, utilizing data from the MIMIC-IV (v3.0) database, aimed to assess ALBI's predictive value for 28-day all-cause mortality in 338 adult ARDS patients admitted to the ICU. Patients were stratified into survivors (209 cases) and nonsurvivors (129 cases), with a 28-day mortality rate of 38.2%. Multivariable Cox regression identified ALBI as an independent predictor of 28-day mortality (HR = 1.46, 95% CI: 1.09-1.95, p=0.011). Receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 61.1% (95% CI: 54.7%-67.4%) with an optimal ALBI cutoff of -1.681; Kaplan-Meier (KM) survival curves confirmed significantly higher mortality in patients with ALBI ≥-1.681 versus ALBI <-1.681 (p=0.0098). Subgroup analyses revealed no significant interactions between ALBI and clinical variables (interaction p: 0.672-0.85). These findings demonstrate ALBI's utility as a novel, independent prognostic marker for short-term mortality risk in ARDS patients.

Keywords: 28 days; acute respiratory distress syndrome; albumin-bilirubin; all-cause mortality; cohort; prognosis.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Schematic diagram of study sample selection steps. ALBI, albumin–bilirubin grade; ARDS, acute respiratory distress syndrome; ICU, intensive care unit; MIMIC, medical information mart for intensive care.
Figure 2
Figure 2
ROC curves of peripheral differential albumin–bilirubin correlate for predicting in-hospital mortality. The black solid line indicates the ROC curve for albumin–bilirubin. ALBI, albumin–bilirubin.
Figure 3
Figure 3
Kaplan–Meier survival analysis curves for all-cause mortality within 28 days of hospital admission.
Figure 4
Figure 4
Forest plot for subgroup analysis of the relationship between hospital mortality and ALBI. ALBI, albumin–bilirubin; CKD, chronic kidney disease; SAPSⅡ, simplified acute physiology score Ⅱ; SOFA, sequential organ failure assessment.
See this image and copyright information in PMC

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