Association between the development of sepsis and the BAR index in patients with acute pancreatitis: A retrospective investigation based on MIMIC-IV database

Sepsis, as a severe complication of acute pancreatitis (AP), needs to be identified and treated as early as possible. The blood urea nitrogen-to-albumin ratio (BAR) index has shown good predictive ability in many studies. However, its effectiveness in predicting AP complicated by sepsis has not been further verified. Therefore, this study mainly discusses the correlation between BAR and the risk of sepsis, aiming to provide a simple and early warning tool for sepsis risk stratification in AP patients. This retrospective cohort study analyzed the data of 779 AP patients from the Medical Information Mart for Intensive Care database 3.1. Critically ill participants admitted between 2008 and 2022 at the Beth Israel Deaconess Medical Center in Boston were included. According to the Sepsis 3.0 diagnostic criteria, the AP patients included in the study were further divided into a sepsis group and a non-sepsis group. The Boruta algorithm, combined with the extreme gradient boosting model, was used to screen variables beneficial to the outcome. Univariate and multivariate logistic regression were used to evaluate the relationship between the BAR index and the occurrence of sepsis after admission. The results showed that the BAR index was significantly associated with the occurrence of sepsis, and the risk of sepsis increased with the increase in the BAR index (all P values for trend < .001). Subgroup analysis showed that the BAR index was positively correlated with the probability of sepsis in patients of different ages, genders, and those with hypertension and diabetes (all P for interaction > .05). The area under the curve of the combined use of the BAR index and clinical indicators was 0.704 (0.667-0.741), which was significantly higher than that of using the BAR index alone, 0.611 (0.572-0.651), with a statistically significant difference (P < .001). In conclusion, the study results suggest that the BAR index may help identify which AP patients are at a higher risk of developing sepsis.