Prognostic value of the Glucose-to-Albumin ratio in sepsis-related mortality: A retrospective ICU study.

AIMS: To investigate the prognostic value of the glucose-to-albumin ratio (GAR) in predicting 30-day and 90-day mortality in septic ICU patients.

METHODS

Kaplan-Meier analysis with log-rank tests assessed survival by GAR quartiles. Multivariable Cox regression and restricted cubic splines (RCS) explored GAR's relationship with mortality. ROC curves evaluated predictive performance, and Boruta identified key variables. Machine learning models assessed GAR's predictive ability, with indirect effects analyzed through anion gap and BUN.

RESULTS

Quartile 4 exhibited the lowest survival probability (log-rank p < 0.0001). GAR demonstrated the highest AUC for 30-day (0.66) and 90-day (0.65) mortality among individual predictors, while the stacked model achieved an AUC of 0.826. Cox regression showed GAR was independently associated with both 30-day (HR: 1.071 (95 % CI: 1.063-1.078, p < 0.001).) and 90-day mortality (HR: 1.071 (95 % CI: 1.064-1.078, p < 0.001). RCS analysis revealed an L-shaped relationship between GAR and mortality.

CONCLUSIONS

GAR is a strong predictor of 30-day and 90-day mortality in septic ICU patients. Incorporating GAR into clinical risk models could improve decision-making and sepsis management.