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Supplementary file 1_Early-admission serum albumin and hospitalization burden in a selected serial-culture cohort of patients with diabetic foot ulcers and subsequent Pseudomonas aeruginosa detection: a retrospective cohort study.docx Feifei Kan (18581473) Aihong Wang (684123) Youliang Tan (25151814) Huizhen Dai (11268401) Cell Metabolism diabetic foot ulcer hospital charges length of stay prognostic assessment Pseudomonas aeruginosa serum albumin Background<p>Patients with diabetic foot ulcers (DFUs) who undergo repeat wound culture and subsequent Pseudomonas aeruginosa (PA) detection form a selected clinical trajectory. Early-admission serum albumin reflects inflammation, capillary permeability, hepatic synthesis, protein loss, hydration, and nutritional reserve; it is not a stand-alone measure of nutritional status. We examined its association with hospitalization burden conditional on this serial-culture trajectory.</p>Methods<p>This single-center retrospective cohort included 408 hospitalized patients with DFU who had a PA-positive wound culture after an earlier non-PA culture during the same admission. Because cohort eligibility required continued hospitalization until repeat sampling and later PA detection, inference was conditional on a post-admission selection event susceptible to immortal-time and collider-selection bias. The culture sequence was an operational ascertainment pattern, not evidence of nosocomial acquisition, microbiological conversion, or invasive PA infection. The co-primary outcomes were length of stay (LOS) and institution-specific nominal hospital charges. Negative binomial and gamma log-link models estimated adjusted within-cohort associations. Exploratory prognostic analyses used bootstrap optimism correction and same-center temporal assessment (development, 2013–2016; assessment, 2017–2018).</p>Results<p>Among 408 patients [261 men (64.0%)], median LOS was 14 days [interquartile range (IQR), 9–19] and median nominal hospital charges were CNY 18,708 (IQR, 12,532–27,979). Compared with albumin ≥35 g/L, albumin 30 to <35 g/L was associated with longer LOS [adjusted rate ratio (aRR), 1.24; 95% CI, 1.10–1.40] and higher charges [adjusted charge ratio (aCR), 1.28; 95% CI, 1.12–1.46]; corresponding estimates for albumin <30 g/L were 1.52 (95% CI, 1.29–1.78) and 1.67 (95% CI, 1.40–1.99). Per 5-g/L lower albumin, the aRR for LOS was 1.19 (95% CI, 1.14–1.25) and the aCR for charges was 1.22 (95% CI, 1.16–1.28). Baseline-only estimates changed by less than 3% on the log-ratio scale. Adding albumin increased the apparent area under the curve (AUC) from 0.679 to 0.758 (optimism-corrected, 0.643 to 0.729; ΔAUC, 0.079; bootstrap 95% CI, 0.036–0.120). In the same-center temporal assessment sample (126 patients; 50 events), the AUC was 0.592 for the core model and 0.719 after albumin was added; corresponding Brier scores were 0.234 and 0.204, and calibration slopes were 0.625 and 0.994. These small-sample performance estimates were treated as descriptive. The median bootstrap-optimal albumin cutoff was 35 g/L (95% bootstrap percentile interval, 33–37 g/L).</p>Conclusions<p>Within this selected serial-culture cohort, lower early-admission albumin was associated with greater hospitalization burden and with numerically better exploratory prognostic performance in same-center analyses. These findings do not establish causality, transportability, a diagnosis of malnutrition, or a clinically actionable albumin threshold.</p> 2026-10-01T04:31:56Z Dataset Dataset 10.3389/fendo.2026.1918069.s001 https://figshare.com/articles/dataset/Supplementary_file_1_Early-admission_serum_albumin_and_hospitalization_burden_in_a_selected_serial-culture_cohort_of_patients_with_diabetic_foot_ulcers_and_subsequent_Pseudomonas_aeruginosa_detection_a_retrospective_cohort_study_docx/34038183 CC BY 4.0