{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:17:23Z","timestamp":1792001843468,"version":"4.4.0"},"reference-count":34,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the Shenzhen Science and Technology Program","award":["JCYJ20190809160001751"],"award-info":[{"award-number":["JCYJ20190809160001751"]}]},{"name":"the Shenzhen Science and Technology Program","award":["JCYJ20210324111013036"],"award-info":[{"award-number":["JCYJ20210324111013036"]}]},{"name":"Baoan Medical Association Medical Research Project","award":["BAYXH2023024"],"award-info":[{"award-number":["BAYXH2023024"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Sepsis-associated acute kidney injury (SA-AKI) is a critical complication associated with negative outcomes. However, the effective prevention of SA-AKI is limited. This retrospective cohort study, which used the MIMIC-IV database, investigated the association between fibrinogen-to-albumin ratio (FAR) and SA-AKI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>The retrospective cohort study involved 1,771 sepsis patients in MIMIC-IV database. Multivariable logistic and Cox regression models were used to estimate ORs\/HRs with 95% CIs for incident SA-AKI. Sensitivity analyses, including stratified analyses and RCS curve, assessed the strength of the association. The predictive performance was compared to other marker using ROC curves and AUCs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>An elevated FAR level (\u2265110.74) was found to be associated with an elevated risk of SA-AKI (adjusted OR 1.55, 95%CI 1.11\u20132.18, P\u2009=\u20090.011), but the association was timing, it reached statistical significance only when SA-AKI occurred after ICU day 3 (adjusted HR 5.17, 95%CI 1.81\u201314.72, P\u2009=\u20090.002). Subgroup analyses indicated that chronic obstructive pulmonary disease (COPD) and hypertension interacted in this association. In sepsis patients without COPD and hypertension, high FAR (\u2265110.74) was linked to SA-AKI (adjusted OR 2.31, 95%CI 1.40\u20133.82, P\u2009=\u20090.001), with statistical significance also occurring 3 days after ICU admission (adjusted HR 8.57, 95%CI 1.88\u201338.94, P\u2009=\u20090.005). The RCS curve showed a linear relationship between FAR and SA-AKI (P for non-linearity: 0.415). ROC analyses showed that FAR combined with SOFA slightly outperformed SOFA alone (AUC 0.697 vs. 0.678, P\u2009=\u20090.004).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>An elevated FAR level was associated with an increased incidence of SA-AKI in patients without COPD and hypertension. However, this association reached statistical significance only when SA-AKI occurred after ICU day 3. Further research is needed to investigate this association.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343549","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T18:27:18Z","timestamp":1772821638000},"page":"e0343549","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of fibrinogen to albumin ratio with sepsis-associated acute kidney injury: A retrospective cohort study based on the MIMIC-IV database"],"prefix":"10.1371","volume":"21","author":[{"given":"Tuan","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muyan","family":"Diao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuojian","family":"Zeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiwen","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1674-541X","authenticated-orcid":true,"given":"Shengyuan","family":"Su","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6502-698X","authenticated-orcid":true,"given":"Yuehui","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"issue":"2","key":"pone.0343549.ref001","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.ccc.2020.11.010","article-title":"Sepsis-associated acute kidney injury","volume":"37","author":"CL Manrique-Caballero","year":"2021","journal-title":"Crit Care Clin"},{"issue":"5","key":"pone.0343549.ref002","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1016\/j.kint.2019.05.026","article-title":"Acute kidney injury from sepsis: Current concepts, epidemiology, pathophysiology, prevention and treatment","volume":"96","author":"S Peerapornratana","year":"2019","journal-title":"Kidney Int"},{"issue":"6","key":"pone.0343549.ref003","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1038\/s41581-023-00683-3","article-title":"Sepsis-associated acute kidney injury: Consensus report of the 28th Acute Disease Quality Initiative workgroup","volume":"19","author":"A Zarbock","year":"2023","journal-title":"Nat Rev Nephrol"},{"issue":"1","key":"pone.0343549.ref004","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1186\/s12957-020-1786-2","article-title":"Albumin-fibrinogen ratio and fibrinogen-prealbumin ratio as promising prognostic markers for cancers: An updated meta-analysis","volume":"18","author":"D-W Sun","year":"2020","journal-title":"World J Surg Oncol"},{"issue":"7","key":"pone.0343549.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0271882","article-title":"Association of albumin, fibrinogen, and modified proteins with acute coronary syndrome","volume":"17","author":"NN Binti","year":"2022","journal-title":"PLoS One"},{"key":"pone.0343549.ref006","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2020\/7280708","article-title":"Albumin-to-fibrinogen ratio independently predicts 28-day mortality in patients with peritonitis-induced sepsis","volume":"2020","author":"H Tai","year":"2020","journal-title":"Mediators of Inflammation"},{"key":"pone.0343549.ref007","article-title":"Fibrinogen\/Albumin ratio: A more powerful prognostic index for patients with end-stage renal disease","author":"Y Zou","year":"2020","journal-title":"Eur J Clin Invest"},{"issue":"12","key":"pone.0343549.ref008","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1016\/j.ijsu.2014.07.013","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies","volume":"12","author":"E von Elm","year":"2014","journal-title":"Int J Surg"},{"issue":"1","key":"pone.0343549.ref009","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/sextrans-2015-052360","article-title":"Routinely collected electronic health data and STI research: RECORD extension to the STROBE guidelines","volume":"92","author":"MY Chen","year":"2016","journal-title":"Sex Transm Infect"},{"issue":"1","key":"pone.0343549.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"},{"key":"pone.0343549.ref011","unstructured":"Johnson A, Bulgarelli L, Pollard T, Horng S, Celi LA, Mark R. 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