Prognostic Value of the Total Bilirubin-to-Albumin Ratio in Critically Ill Patients with Gastrointestinal Bleeding: A Multicentre Cohort Study
In brief
High bilirubin-to-albumin ratio doubles 28-day mortality risk in ICU patients with GI bleed
In a multicenter cohort of 1,627 critically ill adults with gastrointestinal bleeding, a high total bilirubin-to-albumin ratio was linked to more than twice the odds of dying within 28 days, independent of other factors. A nomogram that adds TBAR to SOFA and other variables predicts mortality with about 80% accuracy, though prospective validation is still needed.
- Journal
- Emergency medicine international (Q2)
- Published
- 25 July 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Xuyong Chen, Shasha Ying, Xiangshu Yuan, Lihong Lv, Xingyi Yang
- PMID
- 42502493
- DOI
- 10.1155/emmi/1396680
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 27 July 2026).
Abstract
INTRODUCTION: The total bilirubin-to-serum albumin ratio (TBAR) has been proposed as an indicator of hepatic dysfunction and systemic inflammation, yet its prognostic relevance in critically ill patients with gastrointestinal bleeding (GIB) remains unclear. This study evaluated the association between TBAR and mortality and developed a TBAR-based prognostic model. METHODS: Data were extracted from the MIMIC-IV v3.1 database, with external validation using the eICU-CRD v2.0. Adult patients with GIB were included after applying predefined eligibility criteria, yielding a final cohort of 1627 individuals. The primary outcomes were 28-day all-cause mortality. Cox regression, Kaplan-Meier analyses, restricted cubic splines (RCS), ROC curves, and subgroup analyses were performed. A prediction nomogram was constructed using variables selected through the Boruta algorithm and evaluated using AUC, C-index, calibration performance, and decision curve analysis. RESULTS: Nonsurvivors exhibited markedly greater physiological instability, more severe organ dysfunction, and substantially higher TBAR levels. TBAR was independently associated with mortality across all Cox models (fully adjusted HR for 28-day mortality: 1.10, 95% CI 1.06-1.15). High TBAR was associated with more than a twofold increased risk of death. TBAR demonstrated superior discriminatory ability compared with TBIL or ALB alone and provided incremental predictive value when combined with the SOFA score. RCS analysis supported a linear dose-response association. Subgroup analyses showed no significant interactions. The final nomogram-which incorporated SOFA, APTT, TBAR, vasopressor use, CRRT, and anion gap-achieved an AUC of 0.794 and a bootstrap-corrected C-index of 0.789. External validation in the eICU cohort confirmed the robustness of the association and the strong performance of the model (AUC 0.805). CONCLUSIONS: TBAR is an independent predictor of mortality in critically ill patients with GIB. The TBAR-based nomogram demonstrates reliable discrimination and calibration and may facilitate individualized mortality risk stratification in clinical practice.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.