Shock (Augusta, Ga.) · 2026
Prognostic Significance of the Prothrombin Time-International Normalized Ratio to Albumin Ratio in Cancer Patients with Complication of Sepsis: A Retrospectively Cohort Study.
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Wang Tianyang, Liu Dandan, Niu Fangfang, Quan Zhen, Liu Haitao, Xu Jingjing
Аннотация
BACKGROUND: Accumulating evidence supports the use of the prothrombin time-international normalized ratio-to-albumin ratio (PTAR) as a prognostic biomarker in various diseases. This study evaluated whether PTAR, an easily measurable index, predicts short- and long-term all-cause mortality in cancer patients with sepsis (cancer sepsis).
METHODS: This retrospective cohort study used data from 1,584 adult cancer-sepsis patients in the intensive care unit from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (v3.1) and 82 patients from a Chinese tertiary oncology hospital. Mortality at 28 and 365 days was analyzed using multivariable Cox models, restricted cubic splines, Kaplan-Meier curves, and subgroup analyses. Discriminatory performance was assessed with the area under the receiver operating characteristic curve (AUC), comparing PTAR with the Sequential Organ Failure Assessment (SOFA) score, international normalized ratio (INR), and serum albumin (ALB). AUC differences were tested using DeLong's test.
RESULTS: In the MIMIC-IV cohort, patients in the highest PTAR quartile (Q4) had significantly higher risks of 28-day (adjusted heart rate = 2.038) and 365-day mortality (adjusted heart rate = 1.615). PTAR showed superior discrimination compared with the SOFA score and INR at both time points. In the Chinese cohort, PTAR also predicted 28-day mortality (adjusted heart rate = 4.682), with better AUC (0.721) than SOFA (0.564).
CONCLUSIONS: PTAR at intensive care unit admission independently predicts 28-day mortality in cancer patients with sepsis in both the MIMIC-IV and Chinese cohorts, outperforming SOFA and INR. The 365-day mortality was validated only in the MIMIC-IV cohort, where PTAR demonstrated stronger predictive performance compared with INR and SOFA. Therefore, PTAR can serve as a complementary biomarker to be used in conjunction with existing clinical scoring systems and laboratory indicators, providing additional risk assessment information for cancer-sepsis.
METHODS: This retrospective cohort study used data from 1,584 adult cancer-sepsis patients in the intensive care unit from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database (v3.1) and 82 patients from a Chinese tertiary oncology hospital. Mortality at 28 and 365 days was analyzed using multivariable Cox models, restricted cubic splines, Kaplan-Meier curves, and subgroup analyses. Discriminatory performance was assessed with the area under the receiver operating characteristic curve (AUC), comparing PTAR with the Sequential Organ Failure Assessment (SOFA) score, international normalized ratio (INR), and serum albumin (ALB). AUC differences were tested using DeLong's test.
RESULTS: In the MIMIC-IV cohort, patients in the highest PTAR quartile (Q4) had significantly higher risks of 28-day (adjusted heart rate = 2.038) and 365-day mortality (adjusted heart rate = 1.615). PTAR showed superior discrimination compared with the SOFA score and INR at both time points. In the Chinese cohort, PTAR also predicted 28-day mortality (adjusted heart rate = 4.682), with better AUC (0.721) than SOFA (0.564).
CONCLUSIONS: PTAR at intensive care unit admission independently predicts 28-day mortality in cancer patients with sepsis in both the MIMIC-IV and Chinese cohorts, outperforming SOFA and INR. The 365-day mortality was validated only in the MIMIC-IV cohort, where PTAR demonstrated stronger predictive performance compared with INR and SOFA. Therefore, PTAR can serve as a complementary biomarker to be used in conjunction with existing clinical scoring systems and laboratory indicators, providing additional risk assessment information for cancer-sepsis.