Acute Crit Care.  2020 Feb;35(1):24-30. 10.4266/acc.2019.00738.

The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease

• Choi JS
• Chung KS
• Lee EH
• Lee SH
• Lee SH
• Kim SY
• Jung JY
• Kang YA
• Park MS
• Kim YS
• Chang J
• Leem AY

• KMID: 2500947
• DOI: http://doi.org/10.4266/acc.2019.00738

Abstract

Background
Hyperbilirubinemia and hypoalbuminemia are frequently appeared and associated with poor prognosis in critically ill patients. We aim to evaluate the association between the bilirubin to albumin ratio and prognosis in intensive care unit (ICU) patients. Methods: This was a retrospective study of 731 patients who were admitted to the medical intensive care unit (MICU) at a tertiary-care center from July 2015 to September 2017. We analyzed the bilirubin to albumin ratio on admission to the MICU, including clinical characteristics and other examinations. Results: The overall 28-day survival of MICU patients was 69.1%. On univariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.001), Sequential Organ Failure Assessment score (P<0.001), Simplified Acute Physiology Score II score (P<0.001), Creactive protein (P=0.015), and bilirubin/albumin ratio (P<0.001) were associated with mortality of ICU patients. The receiver operating characteristic curves for ICU patients mortality between bilirubin to albumin ratio and APACHE II score were not statistically significant (P=0.282). On multivariate analysis, higher APACHE II score (hazard ratio [HR], 1.05; 95% CI, 1.03 to 1.06; P<0.001) and bilirubin to albumin ratio (HR, 1.65; 95% CI, 1.23 to 2.20; P=0.001) were independently related to the ICU patient mortality. Conclusions: A higher bilirubin to albumin ratio was related to the unfavorable prognosis and mortality in critically ill patients.

Keyword

albumin; bilirubin; critically ill; mortality; prognosis

Figure

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  Figure 1. Flowchart of inclusion and exclusion process for patient enrollment. A total of 867 patients were enrolled, and 731 patients were included in the analysis. ICU: intensive care unit.

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  Figure 2. Receiver operating characteristic (ROC) curve of serum bilirubin, bilirubin/albumin ratio, and Acute Physiology and Chronic Health Evaluation (APACHE) II score curves as predictors of 28- day mortality. The area under curve for the bilirubin/albumin ratio is not significantly inferior to APACHE II score (P=0.282).

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  Figure 3. Kaplan-Meier analysis of time to death in intensive care unit (ICU) patients according to bilirubin to albumin (B/A) ratio ≤0.31 or >0.31 (P<0.001).

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