Association of Albumin-to-D-Dimer Ratio with Mortality in Mechanically Ventilated Intensive Care Patients

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Objectives: Systemic inflammation, coagulopathy, and multiorgan dysfunction are common in critically ill patients and contribute significantly to mortality. Serum albumin and D-dimer are routinely used biomarkers that reflect nutritional status and coagulation activity, respectively. This study aimed to investigate the prognostic value of the albumin-to-D-dimer ratio (ADR) in predicting 30-day mortality among patients admitted to the intensive care unit (ICU) and undergoing mechanical ventilation. Methods: This retrospective cohort study included 162 adult patients who underwent invasive mechanical ventilation in the ICU of a tertiary care center between January 2021 and December 2023. Demographic data, comorbidities, and laboratory values—such as serum albumin, D-dimer, lactate, CRP, BUN, creatinine, INR, and platelet count—were recorded within the first 24 h of ICU admission. The albumin-to-D-dimer ratio (ADR) was calculated by dividing serum albumin (g/dL) by D-dimer (μg/mL). The patients were stratified into tertiles based on ADR values: low (<0.95), intermediate (0.95–1.45), and high (>1.45). The association between the ADR and 30-day mortality was analyzed using multivariate logistic regression and receiver operating characteristic (ROC) curve analysis. Results: Of the 162 patients included in the study, 61 (37.7%) died within 30 days. The patients who died had significantly lower ADR values at ICU admission compared to survivors (1.02 ± 0.43 vs. 1.56 ± 0.52, p < 0.001). In the multivariate logistic regression model, a lower ADR remained an independent predictor of 30-day mortality (OR: 0.39; 95% CI: 0.26–0.58; p < 0.001), even after adjusting for age, lactate, creatinine, INR, and other relevant clinical variables. ROC curve analysis demonstrated that the ADR had the highest discriminative performance among all the evaluated parameters, with an AUC of 0.802 (95% CI: 0.728–0.875; p < 0.001). The optimal cut-off value for the ADR was identified as <1.05, yielding a sensitivity of 78.7% and a specificity of 71.4% in predicting 30-day mortality. Conclusions: The ADR is independently associated with 30-day mortality in mechanically ventilated ICU patients and may serve as a useful early prognostic marker. However, given the retrospective, single-center nature of this study, these findings should be interpreted with caution. Further prospective, multicenter studies are needed to validate the clinical utility of the ADR.

ADR may aid mortality risk stratification in ventilated ICU patients; hypothesis-generating and requires prospective validation before clinical adoption.