{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:47:13Z","timestamp":1791478033447,"version":"4.3.4"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>The Total Bilirubin-to-Albumin Ratio (TBAR) is widely recognized and applied as a biomarker in the prognostic evaluation of various diseases. However, its role in predicting survival outcomes in patients with acute pancreatitis (AP) remains underexplored. This study aims to investigate the association between TBAR levels and mortality rates in AP patients, thereby providing a novel prognostic indicator for clinical use.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>This study investigates the association between TBAR and mortality in AP patients. We stratified patient data using X-tile software to analyze intergroup differences. Risk factors significantly associated with mortality were identified through univariate and multivariate regression analyses. Kaplan-Meier (KM) analysis evaluated TBAR\u2019s impact on survival, while Receiver Operating Characteristic (ROC) analysis assessed its predictive accuracy, sensitivity, and Area Under the Curve (AUC) for mortality. To ensure robustness, we used Restricted Cubic Spline (RCS) modeling to explore non-linear relationships and performed subgroup analyses to verify the consistency of the TBAR mortality association across patient subgroups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Result<\/jats:title>\n<jats:p>This study included 477 patients. Using X-tile software, we set the optimal TBAR cutoff at 1.33 based on 28-day mortality. Patients were categorized into high-risk (TBAR\u2009\u2265\u20091.33) and low-risk (TBAR\u2009&lt;\u20091.33) groups. Elevated TBAR significantly correlated with increased mortality at multiple time points (7, 14, 21, 28, 90, and 365 days; P\u2009&lt;\u20090.05). KM analysis confirmed lower survival rates in the high-risk group at all time points (P\u2009&lt;\u20090.05). ROC analysis showed TBAR\u2019s predictive accuracy for mortality was comparable to the SOFA score and superior to other indicators. RCS modeling revealed a linear TBAR mortality relationship. Subgroup analyses showed no significant interactions between TBAR and most subgroups.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The TBAR is strongly correlated with short-term and long-term mortality in patients with acute pancreatitis.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0323330","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:53:17Z","timestamp":1747936397000},"page":"e0323330","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Total bilirubin-to-albumin ratio and short- and long-term all-cause mortality in acute pancreatitis: Evidence from the MIMIC-IV database"],"prefix":"10.1371","volume":"20","author":[{"given":"XingYi","family":"Yang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"LiHong","family":"Lv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"XuYong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8447-4646","authenticated-orcid":true,"given":"ZhenMei","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"issue":"1","key":"pone.0323330.ref001","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1136\/gutjnl-2012-302779","article-title":"Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus","volume":"62","author":"PA Banks","year":"2013","journal-title":"Gut"},{"issue":"11","key":"pone.0323330.ref002","doi-asserted-by":"crossref","first-page":"2627","DOI":"10.3390\/biomedicines12112627","article-title":"Pancreatic Morphology, Immunology, and the Pathogenesis of Acute Pancreatitis","volume":"12","author":"T Mihoc","year":"2024","journal-title":"Biomedicines"},{"issue":"9","key":"pone.0323330.ref003","doi-asserted-by":"crossref","first-page":"1400","DOI":"10.1038\/ajg.2013.218","article-title":"American College of Gastroenterology guideline: management of acute pancreatitis","volume":"108","author":"American College of Gastroenterology","year":"2013","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"pone.0323330.ref004","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1038\/s41575-018-0087-5","article-title":"Global epidemiology and holistic prevention of pancreatitis","volume":"16","author":"MS Petrov","year":"2019","journal-title":"Nat Rev Gastroenterol Hepatol"},{"issue":"1","key":"pone.0323330.ref005","doi-asserted-by":"crossref","first-page":"3302","DOI":"10.1186\/s12889-024-20773-6","article-title":"Associations between serum levels of liver function biomarkers and all-cause and cause-specific mortality: a prospective cohort study","volume":"24","author":"S Ling","year":"2024","journal-title":"BMC Public Health"},{"issue":"12","key":"pone.0323330.ref006","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1136\/gut.2008.152702","article-title":"The early prediction of mortality in acute pancreatitis: a large population-based study","volume":"57","author":"BU Wu","year":"2008","journal-title":"Gut"},{"issue":"8","key":"pone.0323330.ref007","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s00228-024-03664-y","article-title":"Albumin: a comprehensive review and practical guideline for clinical use","volume":"80","author":"F Abedi","year":"2024","journal-title":"Eur J Clin Pharmacol"},{"issue":"1","key":"pone.0323330.ref008","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12876-017-0615-8","article-title":"Serum albumin, a good indicator of persistent organ failure in acute pancreatitis","volume":"17","author":"S Li","year":"2017","journal-title":"BMC Gastroenterol"},{"key":"pone.0323330.ref009","doi-asserted-by":"crossref","first-page":"706407","DOI":"10.3389\/fmed.2021.706407","article-title":"Pathological Significance and Prognostic Roles of Indirect Bilirubin\/Albumin Ratio in Hepatic Encephalopathy","volume":"8","author":"Y Li","year":"2021","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"pone.0323330.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","article-title":"MIMIC-IV, a freely accessible electronic health record dataset","volume":"10","author":"AEW Johnson","year":"2023","journal-title":"Sci Data"},{"issue":"7872","key":"pone.0323330.ref011","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness. A practical scale","volume":"2","author":"G Teasdale","year":"1974","journal-title":"Lancet"},{"issue":"7","key":"pone.0323330.ref012","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine","volume":"22","author":"JL Vincent","year":"1996","journal-title":"Intensive Care Med"},{"issue":"11","key":"pone.0323330.ref013","doi-asserted-by":"crossref","first-page":"1822","DOI":"10.1177\/0963689717738258","article-title":"Estrogen-Estrogen Receptor \u03b1 Signaling Facilitates Bilirubin Metabolism in Regenerating Liver Through Regulating Cytochrome P450 2A6 Expression","volume":"26","author":"T-L Kao","year":"2017","journal-title":"Cell Transplant"},{"issue":"12","key":"pone.0323330.ref014","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1001\/archsurg.138.12.1375","article-title":"Sex differences in hepatic heme oxygenase expression and activity following trauma and hemorrhagic shock","volume":"138","author":"B Toth","year":"2003","journal-title":"Arch Surg"},{"issue":"1","key":"pone.0323330.ref015","doi-asserted-by":"crossref","DOI":"10.1152\/ajpheart.01247.2004","article-title":"Mechanism of salutary effects of estradiol on organ function after trauma-hemorrhage: upregulation of heme oxygenase","volume":"289","author":"L Szalay","year":"2005","journal-title":"Am J Physiol Heart Circ Physiol"},{"issue":"2","key":"pone.0323330.ref016","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/0016-5085(84)90705-4","article-title":"Influence of sex and sex steroids on bilirubin uridine diphosphate-glucuronosyltransferase activity of rat liver","volume":"87","author":"M Muraca","year":"1984","journal-title":"Gastroenterology"},{"issue":"7","key":"pone.0323330.ref017","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s00011-007-6198-z","article-title":"Modulation of the inflammatory response by estrogens with focus on the endothelium and its interactions with leukocytes","volume":"56","author":"B-O Nilsson","year":"2007","journal-title":"Inflamm Res"},{"issue":"1","key":"pone.0323330.ref018","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1186\/s12876-021-01906-2","article-title":"The global, regional, and national burden of acute pancreatitis in 204 countries and territories, 1990-2019","volume":"21","author":"C-L Li","year":"2021","journal-title":"BMC Gastroenterol"},{"issue":"3","key":"pone.0323330.ref019","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1002\/jhbp.890","article-title":"Sex differences in outcomes of acute pancreatitis: Findings from a nationwide analysis","volume":"28","author":"S Sharma","year":"2021","journal-title":"J Hepatobiliary Pancreat Sci"},{"key":"pone.0323330.ref020","first-page":"9731854","article-title":"Diagnostic Value of Neutrophil-Lymphocyte Ratio for Predicting the Severity of Acute Pancreatitis: A Meta-Analysis","author":"W Kong","year":"2020","journal-title":"Dis Markers"},{"issue":"39","key":"pone.0323330.ref021","doi-asserted-by":"crossref","first-page":"14450","DOI":"10.3748\/wjg.v20.i39.14450","article-title":"Red cell distribution width to platelet ratio: new and promising prognostic marker in acute pancreatitis","volume":"20","author":"E Cetinkaya","year":"2014","journal-title":"World J Gastroenterol"},{"key":"pone.0323330.ref022","doi-asserted-by":"crossref","first-page":"5449","DOI":"10.2147\/IJGM.S327123","article-title":"Prognostic Value of Glucose-to-Lymphocyte Ratio in Critically Ill Patients with Acute Pancreatitis","volume":"14","author":"Y Chen","year":"2021","journal-title":"Int J Gen Med"},{"key":"pone.0323330.ref023","doi-asserted-by":"crossref","first-page":"1076121","DOI":"10.3389\/fimmu.2022.1076121","article-title":"Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database","volume":"13","author":"Q Liu","year":"2022","journal-title":"Front Immunol"},{"issue":"10","key":"pone.0323330.ref024","doi-asserted-by":"crossref","first-page":"2247","DOI":"10.4240\/wjgs.v15.i10.2247","article-title":"Novel prognostic score based on the preoperative total bilirubin-albumin ratio and fibrinogen-albumin ratio in ampullary adenocarcinoma","volume":"15","author":"X-J Zhang","year":"2023","journal-title":"World J Gastrointest Surg"},{"issue":"11","key":"pone.0323330.ref025","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0287485","article-title":"Association between total bilirubin\/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study","volume":"18","author":"X Huang","year":"2023","journal-title":"PLoS One"},{"issue":"2","key":"pone.0323330.ref026","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/j.asjsur.2021.11.044","article-title":"A prognostic model incorporating bilirubin-to-albumin ratio for patients with traumatic brain injury","volume":"45","author":"X Bai","year":"2022","journal-title":"Asian J Surg"},{"issue":"1","key":"pone.0323330.ref027","doi-asserted-by":"crossref","DOI":"10.1042\/BSR20192152","article-title":"Increased serum total bilirubin-albumin ratio was associated with bilirubin encephalopathy in neonates","volume":"40","author":"Y Wang","year":"2020","journal-title":"Biosci Rep"},{"issue":"4","key":"pone.0323330.ref028","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.molmed.2023.01.007","article-title":"The physiology of bilirubin: health and disease equilibrium","volume":"29","author":"L Vitek","year":"2023","journal-title":"Trends Mol Med"},{"issue":"1","key":"pone.0323330.ref029","doi-asserted-by":"crossref","first-page":"16723","DOI":"10.1038\/s41598-024-66710-w","article-title":"Chronic liver disease is an important risk factor for worse outcomes in acute pancreatitis: a systematic review and meta-analysis","volume":"14","author":"J Hoferica","year":"2024","journal-title":"Sci Rep"},{"issue":"4","key":"pone.0323330.ref030","article-title":"Assessing the causal link between liver function and acute pancreatitis: A Mendelian randomisation study","volume":"19","author":"C Zhang","year":"2024","journal-title":"PLoS One"},{"issue":"1","key":"pone.0323330.ref031","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1186\/s40001-024-01963-9","article-title":"Exploring the inverse relationship between serum total bilirubin and systemic immune-inflammation index: insights from NHANES data (2009-2018)","volume":"29","author":"S-S Huang","year":"2024","journal-title":"Eur J Med Res"},{"key":"pone.0323330.ref032","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1038\/s41586-019-1865-0","article-title":"Microbial bile acid metabolites modulate gut ROR\u03b3+ regulatory T cell homeostasis","volume":"577","author":"X Song","year":"2020","journal-title":"Nature"},{"issue":"4","key":"pone.0323330.ref033","first-page":"413","article-title":"Mortality prognostic factors in acute pancreatitis","volume":"9","author":"CC Popa","year":"2016","journal-title":"J Med Life"},{"issue":"8","key":"pone.0323330.ref034","first-page":"865","article-title":"Establishment and evaluation of early in-hospital death prediction model for patients with acute pancreatitis in intensive care unit","volume":"35","author":"L Yu","year":"2023","journal-title":"Zhonghua Wei Zhong Bing Ji Jiu Yi Xue"},{"issue":"1","key":"pone.0323330.ref035","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1186\/s12876-024-03308-6","article-title":"Construction and validation of a nomogram for predicting survival in elderly patients with severe acute pancreatitis: a retrospective study from a tertiary center","volume":"24","author":"Q Zhu","year":"2024","journal-title":"BMC Gastroenterol"},{"issue":"8","key":"pone.0323330.ref036","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1016\/j.pan.2024.10.010","article-title":"Risk score to predict inpatient mortality of acute pancreatitis patients admitted to the intensive care unit","volume":"24","author":"H Ali","year":"2024","journal-title":"Pancreatology"},{"issue":"5","key":"pone.0323330.ref037","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1007\/s00134-021-06394-2","article-title":"Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis","volume":"47","author":"D Chaudhuri","year":"2021","journal-title":"Intensive Care Med"},{"issue":"1","key":"pone.0323330.ref038","doi-asserted-by":"crossref","first-page":"24158","DOI":"10.1038\/s41598-021-03449-8","article-title":"Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality","volume":"11","author":"K Ocskay","year":"2021","journal-title":"Sci Rep"},{"key":"pone.0323330.ref039","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.ejim.2022.05.004","article-title":"Low serum albumin: A neglected predictor in patients with cardiovascular disease","volume":"102","author":"AA Manolis","year":"2022","journal-title":"Eur J Intern Med"},{"issue":"1","key":"pone.0323330.ref040","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1186\/s12876-023-02801-8","article-title":"Albumin infusion may decrease the mortality of hypoalbuminemia patients with severe acute pancreatitis: a retrospective cohort study","volume":"23","author":"H Xu","year":"2023","journal-title":"BMC Gastroenterol"},{"key":"pone.0323330.ref041","first-page":"5297143","article-title":"Serum Albumin Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis","author":"W Hong","year":"2017","journal-title":"Can J Gastroenterol Hepatol"},{"issue":"1","key":"pone.0323330.ref042","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s10753-024-02071-w","article-title":"Gene Regulation of Neutrophils Mediated Liver and Lung Injury through NETosis in Acute Pancreatitis","volume":"48","author":"X Liu","year":"2025","journal-title":"Inflammation"},{"issue":"3","key":"pone.0323330.ref043","doi-asserted-by":"crossref","first-page":"287","DOI":"10.29271\/jcpsp.2019.03.287","article-title":"The Relationship between Liver Injury and Serum Levels of C-Reactive Protein and Procalcitonin in Patients with Acute Pancreatitis","volume":"29","author":"X Li","year":"2019","journal-title":"J Coll Physicians Surg Pak"},{"issue":"5","key":"pone.0323330.ref044","first-page":"806","article-title":"Red cell destruction and bilirubin production in adult rats with short-term biliary obstruction","volume":"5","author":"WL Salomon","year":"1986","journal-title":"J Pediatr Gastroenterol Nutr"},{"issue":"1","key":"pone.0323330.ref045","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1002\/path.1711600112","article-title":"Factors producing bile infarction and bile duct proliferation in biliary obstruction","volume":"160","author":"Y Shibayama","year":"1990","journal-title":"J Pathol"},{"issue":"4","key":"pone.0323330.ref046","doi-asserted-by":"crossref","first-page":"3735","DOI":"10.3390\/ijms24043735","article-title":"Alcohol, Inflammation, and Microbiota in Alcoholic Liver Disease","volume":"24","author":"M Duki\u0107","year":"2023","journal-title":"Int J Mol Sci"},{"issue":"11","key":"pone.0323330.ref047","first-page":"939","article-title":"The Multifaceted Role of Bilirubin in Liver Disease: A Literature Review","volume":"12","author":"MM Ram\u00edrez-Mej\u00eda","year":"2024","journal-title":"J Clin Transl Hepatol"},{"issue":"1","key":"pone.0323330.ref048","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.cld.2018.09.012","article-title":"Nutrition in Alcoholic Liver Disease: An Update","volume":"23","author":"B Styskel","year":"2019","journal-title":"Clin Liver Dis"},{"issue":"4","key":"pone.0323330.ref049","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1001\/jama.2020.20317","article-title":"Acute Pancreatitis: A Review","volume":"325","author":"MA Mederos","year":"2021","journal-title":"JAMA"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323330","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T17:53:32Z","timestamp":1747936412000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323330"}},"subtitle":[],"editor":[{"given":"Xiaosheng","family":"Tan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":49,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,22]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323330","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]}}}