{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:04:46Z","timestamp":1789538686362,"version":"build-2803163510"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>APAR combines alkaline phosphatase and albumin, two routine laboratory measurements. We examined its association with recorded early all-cause mortality within 90 days of admission in hospitalized patients with heart failure (HF), prioritizing continuous APAR over a mortality-derived cutoff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analyzed version 1.3 of the Zigong Heart Failure Database. Among 2,008 patients, 1,906 had calculable APAR and a recorded vital-status outcome within 90 days; 37 deaths were recorded. Exact event times were available for 1,905 patients (36 deaths). The primary model assessed standardized ln(APAR), adjusting for the eight released age categories as a 1\u20138 ordinal score, sex, log(BNP), eGFR, sodium, and CCI, with NYHA class stratification. Mortality timing, post-discharge survival, hemoglobin adjustment, and E-values were examined in sensitivity analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Recorded all-cause mortality within 90 days of admission was 1.94%. In the complete-case model (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091,824; 36 deaths), each 1-SD increase in ln(APAR) was associated with higher mortality (HR 1.375, 95% CI 1.024\u20131.846;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.034), whereas raw APAR per 1\u2005U\/g was not (HR 1.146, 95% CI 0.988\u20131.330;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.072). The spline showed an overall association (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.025) and nonlinearity (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.023). Nine of 37 deaths were confirmed in-hospital. Among 1,897 patients discharged without recorded in-hospital death, 28 died within 90 days: 15 on a later calendar date, 12 on the discharge date, and one with missing exact timing. In the strict post-discharge analysis, the adjusted HR was 1.460 (95% CI 0.931\u20132.289;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.099; 15 events). APAR showed modest discrimination (AUC 0.698), while incremental value was limited:\n                      <jats:italic>\u0394<\/jats:italic>\n                      C-index 0.018 (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.104), IDI 0.0019 (95% CI \u22120.0035 to 0.0252), small decision-curve gains, and continuous NRI 0.179 (95% CI \u22120.129 to 0.577).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher admission ln(APAR) was associated with recorded early all-cause mortality within 90 days of admission, but the association was modest, nonlinear, scale-dependent, and based on few events. Post-discharge estimates were directionally consistent but imprecise. External validation is required before APAR or any cutoff is used for clinical risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1936612","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:31:45Z","timestamp":1789536705000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between the alkaline phosphatase-to-albumin ratio and recorded early all-cause mortality within 90 days of admission in patients with heart failure: a retrospective cohort study in a Chinese population"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhenyu","family":"Yuan","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University","place":["Zhangjiakou, 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Hebei North University","place":["Zhangjiakou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zuo","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University","place":["Zhangjiakou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanzhi","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University","place":["Zhangjiakou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guanli","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Hebei North University","place":["Zhangjiakou, 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