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oai:figshare.com:article/34039839 2026-10-01T05:43:29Z category_393 portal_316 item_type_3 month_year_10_2026

Supplementary file 1_LDAR shows more consistent prognostic performance than other albumin-derived indices for 28-day ICU mortality in critically ill patients with urosepsis: evidence from a dual-cohort retrospective study.docx Yi Mu (519696) Hao Tang (44155) Yan Zeng (120271) Qian Wang (32718) Tao Huang (110613) Wei Li (7081) Xiangbo Wu (9090356) Shengming Pi (25153113) Foetal Development and Medicine albumin-derived indices critical care deep learning nutritional intervention risk stratification Background<p>Urosepsis remains a leading cause of ICU mortality. Albumin-derived composite indices, which integrate nutritional, inflammatory, and metabolic parameters, hold prognostic promise; however, their comparative performance has not been directly assessed.</p>Methods<p>We conducted a dual-cohort retrospective study using MIMIC-IV (n = 3,060) for derivation and the Affiliated Hospital of Guizhou Medical University (n = 353) for validation. The primary outcome was 28-day ICU mortality in a competing-risks framework with discharge alive as competing event. Six indices—lactate dehydrogenase-to-albumin ratio (LDAR), anion gap-to-albumin ratio (AGAR), glucose-to-albumin ratio (GAR), red cell distribution width-to-albumin ratio (RAR), total bilirubin-to-albumin ratio (TAR), and urea nitrogen-to-albumin ratio (UAR)—were compared via cause-specific Cox and Fine-Gray subdistribution hazard models, cumulative incidence functions, restricted cubic splines (RCS), Kaplan-Meier curves, and ROC/Youden/cNRI analyses. LASSO-selected features trained a multilayer perceptron (MLP), benchmarked against six severity scores; a parsimonious external model (events per variable ≥ 10) was also examined.</p>Results<p>In the derivation cohort, logLDAR, RAR, TAR, AGAR, and UAR were independently associated with 28-day ICU mortality in fully adjusted models (HRs = 1.292, 1.147, 1.136, 1.074, and 1.013, respectively; all P < 0.01), whereas logGAR was not. Fine-Gray models corroborated these findings (logLDAR sHR = 1.351, 95% CI: 1.238–1.473). RCS revealed a non-linear logLDAR–mortality relationship (P non-linear = 0.040), with risk accelerating beyond logLDAR > 7. logLDAR yielded the highest AUC (0.638, 95% CI: 0.609–0.667) and cNRI (0.119). External validation confirmed the independent prognostic value of logLDAR (HR = 1.524, 95% CI: 1.225–1.895; Fine-Gray sHR = 1.545, 95% CI: 1.295–1.844), with an external AUC of 0.735 (95% CI: 0.648–0.808), although between-cohort differences in case definitions may partly contribute. The MLP with eight LASSO-selected features achieved an external AUC of 0.762 (95% CI: 0.687–0.840), comparable to SOFA plus logLDAR (AUC = 0.782; DeLong P = 0.512). SHAP analysis ranked logLDAR among the top predictors.</p>Conclusion<p>Among the six albumin-derived indices, logLDAR demonstrated the most consistent and generalizable prognostic performance for 28-day ICU mortality in urosepsis, reflecting both tissue hypoxia and nutritional-inflammatory depletion, and remained robust under competing-risk adjustment. logLDAR may serve as a simple bedside biomarker for early risk stratification; however, prospective studies are warranted to determine whether interventions targeting its underlying pathways can improve outcomes.</p> 2026-10-01T05:43:29Z Dataset Dataset 10.3389/fmed.2026.1915095.s001 https://figshare.com/articles/dataset/Supplementary_file_1_LDAR_shows_more_consistent_prognostic_performance_than_other_albumin-derived_indices_for_28-day_ICU_mortality_in_critically_ill_patients_with_urosepsis_evidence_from_a_dual-cohort_retrospective_study_docx/34039839 CC BY 4.0