Dynamic Serum Albumin Changes and Incremental Prognostic Value in Sepsis-Associated Acute Lung Injury: A Longitudinal-Survival Analysis Using the MIMIC-IV Database

Corresponding author: xushuai, wzszyyjzkxs@163.com

DOI: 10.12201/bmr.202610.00020

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  Abstract: Objective This study aims to evaluate the impact of early dynamic changes in serum albumin levels—encompassing baseline values upon admission and short-term rate of change—on 28-day outcomes in patients with sepsis-associated acute lung injury (ALI), and further assess whether this dynamic marker provides independent prognostic value beyond traditional risk factors.Methods Based on the MIMIC-IV database, 3,071 patients with sepsis complicated by acute lung injury (ALI) were retrospectively included. Using all repeated albumin measurements within 0–72 hours after ICU admission, a longitudinal-survival joint model was constructed to estimate the association between current albumin levels and their rate of change with 28-day all-cause mortality risk. A nested model strategy was employed to assess incremental predictive value. Secondary outcomes included 90-day mortality and ventilator-free days at 28 days. Dynamic albumin analysis is mainly applicable to patients who have had at least two albumin measurements within a period of 0 to 72 hours.Results This study found that each 0.5 g/dL decrease in current albumin level was independently associated with an increased risk of 28-day mortality (hazard ratio HR = 1.289, 95% confidence interval CI: 1.196–1.390, P < 0.001). Meanwhile, among patients with at least two albumin measurements, a steeper decline in albumin levels also significantly increased the risk of death (HR=1.991, 95% CI: 1.048–3.781, P = 0.035). Fluid balance and oxygenation status significantly modified the prognostic effect of albumin (interaction P < 0.05). Adding static albumin to the clinical baseline model improved the AUROC from 0.710 to 0.716; further inclusion of dynamic albumin increased it to 0.727. The calibration slope was favorable (0.958), and the model incorporating dynamic albumin demonstrated positive net benefit within clinically reasonable threshold probability ranges. These findings were further confirmed by sensitivity analyses.Conclusions Early dynamic albumin (especially the current level and the rate of decline) is independently associated with the short-term mortality risk of patients with sepsis complicated by ALI, and provides additional incremental predictive information beyond traditional clinical indicators. Dynamic albumin can serve as an auxiliary indicator to complement the existing risk stratification system. The clinical value of this approach still requires further verification through prospective and multi-center studies.

  Key words: Sepsis；Acute Lung Injury；Serum Albumin；MIMIC-IV Database；Dynamic Prognostic Marker; ; ; ; 

  Submit time: 11 October 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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