Association of Albumin–Bilirubin (ALBI) Grade With 28‐Day All‐Cause Mortality in Patients With Acute Respiratory Distress Syndrome: A Retrospective Analysis of the MIMIC‐IV Database

The albumin-bilirubin (ALBI) grade, a validated prognostic tool in cancers such as hepatocellular carcinoma, has not been evaluated in acute respiratory distress syndrome (ARDS). This retrospective cohort study, utilizing data from the MIMIC-IV (v3.0) database, aimed to assess ALBI's predictive value for 28-day all-cause mortality in 338 adult ARDS patients admitted to the ICU. Patients were stratified into survivors (209 cases) and nonsurvivors (129 cases), with a 28-day mortality rate of 38.2%. Multivariable Cox regression identified ALBI as an independent predictor of 28-day mortality (HR = 1.46, 95% CI: 1.09-1.95, <i>p</i>=0.011). Receiver operating characteristic (ROC) analysis yielded an area under the curve (AUC) of 61.1% (95% CI: 54.7%-67.4%) with an optimal ALBI cutoff of -1.681; Kaplan-Meier (KM) survival curves confirmed significantly higher mortality in patients with ALBI ≥-1.681 versus ALBI <-1.681 (<i>p</i>=0.0098). Subgroup analyses revealed no significant interactions between ALBI and clinical variables (interaction <i>p</i>: 0.672-0.85). These findings demonstrate ALBI's utility as a novel, independent prognostic marker for short-term mortality risk in ARDS patients.