Abstract
BACKGROUND: While the prognostic value of the international normalized ratio - to - albumin ratio (PTAR) has been established in several diseases, its predictive value in acute pancreatitis (AP) mortality remains uncertain. This study aimed to investigate the association between PTAR and survival outcomes in AP patients. METHODS: Initial screening using univariate and multivariate regression analysis identified significant prognostic variables. Survival distributions according to different PTAR levels were compared using the Kaplan - Meier (K - M) method. Receiver operating characteristic (ROC) curves were used to evaluate its discriminative performance in terms of sensitivity and specificity. Nonlinear relationships of PTAR with survival outcomes were assessed using restricted cubic spline (RCS) regression, and stratified cohort examinations were conducted to address potential confounding effects. RESULT: A total of 459 patients were enrolled in this study. They were categorized into two groups based on their PTAR scores: high - risk (≥ 0.58) and low - risk (< 0.58). A significant association was found between elevated PTAR and increased mortality at various time points, such as 7, 14, 21, 28, 90, and 365 days (P < 0.05). The Cox proportional hazards model revealed a significant independent association between higher PTAR and mortality, with hazard ratios consistently significant across all time points (P < 0.05). Patients in the high - risk group showed persistently higher mortality rates (P < 0.05 for all comparative time points). ROC analysis showed similar predictive performance of PTAR and the SOFA score for mortality. No statistically significant interaction between PTAR status and treatment effects was observed (p > 0.05). CONCLUSION: PTAR has shown significant associations with clinical outcomes in patients with AP.