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.

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.