Impact of admission-blood-glucose-to-albumin ratio on all-cause mortality and renal prognosis in critical patients with coronary artery disease: insights from the MIMIC-IV database

Yong Hong; Bo-Wen Zhang; Jing Shi; Ruo-Xin Min; Ding-Yu Wang; Jiu-Xu Kan; Yun-Long Gao; Lin-Yue Peng; Ming-Lu Xu; Ming-Ming Wu; Yue Li; Li Sheng

doi:10.26599/1671-5411.2025.06.001

Impact of admission-blood-glucose-to-albumin ratio on all-cause mortality and renal prognosis in critical patients with coronary artery disease: insights from the MIMIC-IV database

J Geriatr Cardiol. 2025 May 28;22(6):563-577. doi: 10.26599/1671-5411.2025.06.001.

Authors

Yong Hong^#^{1

2}, Bo-Wen Zhang^#^{1

2}, Jing Shi^#^{1

2}, Ruo-Xin Min^{1

2}, Ding-Yu Wang^{1

2}, Jiu-Xu Kan^{1

2}, Yun-Long Gao^{1

2}, Lin-Yue Peng^{1

2}, Ming-Lu Xu^{1

2}, Ming-Ming Wu^{1

3}, Yue Li^{1

2

4}, Li Sheng^{1

2}

Affiliations

¹ Harbin Medical University, Harbin, China.
² Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
³ Departments of Cardiology and Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, NHC Key Laboratory of Cell Transplantation, Key Laboratories of Education Ministry for Myocardial Ischemia Mechanism and Treatment, Harbin, China.
⁴ Heilongjiang Province Clinical Medical Research Center for Hypertension, the First Affiliated Hospital of Harbin Medical University, Harbin, China.

^# Contributed equally.

Abstract

Background: Blood glucose and serum albumin have been associated with cardiovascular disease prognosis, but the impact of admission-blood-glucose-to-albumin ratio (AAR) on adverse outcomes in critical ill coronary artery disease (CAD) patients was not investigated.

Methods: Patients diagnosed with CAD were non-consecutively selected from the MIMIC-IV database and categorized into quartiles based on their AAR. The primary outcome was 1-year mortality, and secondary endpoints were in-hospital mortality, acute kidney injury (AKI), and renal replacement therapy (RRT). A restricted cubic splines model and Cox proportional hazard models assessed the association between AAR and adverse outcomes in CAD patients. Kaplan-Meier survival analysis determined differences in endpoints across subgroups.

Results: A total of 8360 patients were included. There were 726 patients (8.7%) died in the hospital and 1944 patients (23%) died at 1 year. The incidence of AKI and RRT was 63% and 4.3%, respectively. High AAR was markedly associated with in-hospital mortality (HR = 1.587, P = 0.003), 1-year mortality (HR = 1.502, P < 0.001), AKI incidence (HR = 1.579, P < 0.001), and RRT (HR = 1.640, P < 0.016) in CAD patients in the completely adjusted Cox proportional hazard model. Kaplan-Meier survival analysis noted substantial differences in all endpoints based on AAR quartiles. Stratified analysis and interaction test demonstrated stable correlations between AAR and outcomes.

Conclusions: The results highlight that AAR may be a potential indicator for assessing in-hospital mortality, 1-year mortality, and adverse renal prognosis in critical CAD patients.