Investigating MACE prediction following CABG using Albumin-Bilirubin scores: Analysis of the MIMIC-IV database

The potential of Albumin-Bilirubin (ALBI) score extends beyond liver function assessment to cardiovascular outcomes. Given the prevalence of major adverse cardiovascular events (MACE) post-coronary artery bypass grafting (CABG), we explored the predictive relationship between ALBI scores and MACE using the MIMIC-IV database. Drawing from the MIMIC-IV database's extensive ICU patient records, we conducted a retrospective cohort analysis. After stratifying CABG patients by ALBI scores, we employed multivariate Cox proportional hazards models to examine MACE occurrence, with appropriate adjustment for confounding factors. Our analysis using LassoCox regression and random forest models revealed distinct patterns in ALBI's prognostic utility. While LassoCox highlighted significant predictive strength in both ALBI and FIB4, with minimal MLR influence, random forest analysis identified ALBI and MLR as crucial predictors. Survival analyses demonstrated that elevated ALBI scores significantly correlated with reduced survival in patients with heart failure, malignant cancer, and severe liver disease (p < 0.001). Though renal disease patients showed a similar trend, it did not reach statistical significance (p = 0.147). The ALBI score has strong prognostic significance in various comorbidities, especially heart failure, malignancy, and severe liver disease. Incorporating the ALBI into clinical risk assessment may improve patient care strategies after coronary artery bypass grafting.