Deceased serum bilirubin and albumin levels in the assessment of severity and mortality in patients with acute pancreatitis

Background: Our study investigated the diagnostic and prognostic role of serum antioxidant indexes in patients with acute pancreatitis (AP). Methods: This study included 708 AP patients from the Medical Information Mart for Intensive Care-III (MIMIC-III) database and 477 patients from the eICU Collaborative Research Database (eICU-CRD). X-tile software was applied to determine the best cutoff values for serum antioxidant indexes. Univariate and multivariate regression analyses were employed to select variables associated with severe AP (SAP) and in-hospital mortality. Finally, the nomograms were also externally validated in the eICU-CRD. Results: The best cutoff values for serum total bilirubin (TBIL) and albumin were 1.1 mg/dL and 2.1 g/dL in the training set, respectively. Multivariate logistical regression indicated that both TBIL (odds ratio [OR]=0.740, 95% confidence interval [CI]: 0.616-0.889, P=0.001) and albumin (OR=0.890, 95%CI: 0.819-0.967, P=0.006) were independent risk factors for SAP. Similarly, multivariate Cox analysis revealed that serum TBIL (hazard ratio [HR]=0.768, 95%CI:0.635-0.928, P=0.006) and albumin (HR=0.962, 95%CI:0.927-0.998, P=0.037) were independent risk factors for in-hospital mortality in AP patients. The diagnostic nomogram containing TBIL, albumin, Sequential Organ Failure Assessment (SOFA) score and urea nitrogen and prognostic nomogram combining TBIL, albumin, white blood count, SOFA score, and age obtained good discrimination, calibration and clinical utility in both the MIMIC-III and eICU-CRD. Conclusion: Serum TBIL and albumin were independent predictors for SAP and in-hospital mortality in AP patients. The nomograms combining serum TBIL and albumin with other significant features exerted favorable predictive performance for SAP and in-hospital mortality.