Risk of acute kidney injury associated with the albumin–bilirubin score in ICU patients with acute pancreatitis

Acute kidney injury (AKI) is a frequent and clinically significant complication in patients with acute pancreatitis (AP), and early recognition is essential for optimal management. This study investigated the association between the albumin–bilirubin (ALBI) score and the development of AKI in critically ill patients with AP. Clinical data for first-time intensive care unit (ICU) admissions with a confirmed AP diagnosis were retrospectively extracted from the Medical Information Mart for Intensive Care IV database. Total bilirubin and albumin were collected within the first 24 hours of ICU admission. Multivariable logistic regression models were used to assess the association between ALBI score (as continuous, binary, and tertile variables) and AKI risk, adjusting for confounders including demographics, comorbidities, and laboratory values. A total of 529 ICU patients with AP were included, with an AKI incidence of 69.4%. Multivariable analyses demonstrated a significant linear association between a higher ALBI score and increased risk of AKI. These findings remained consistent across subgroup and sensitivity analyses. After adjusting for potential confounders, each 1-unit increase in ALBI score was associated with a 109% increase in the risk of AKI (odds ratio [OR] = 2.09; 95% confidence interval [CI] = 1.39–3.15; P < .001). When categorized, patients in the highest ALBI groups had significantly higher risk compared to the reference groups (grade 3: OR = 1.98; 95% CI = 1.24–3.17, P = .004; T3: OR = 2.18; 95% CI = 1.24–3.84, P = .007). Upon admission, a higher ALBI score is independently associated with AKI in ICU patients with AP. These results underscore the potential of the ALBI score as a valuable tool for early risk stratification in critically ill patients with AP. Multicenter and larger sample sizes are needed to validate these findings.