Association of 30-Day Mortality With Lactate-to-Calcium Ratio in ICU Patients With Acute Pancreatitis: Development of a Predictive Model

Background: Global incidence of acute pancreatitis (AP) is rising. Early mortality prediction is crucial for treatment decisions. This study aims to develop a more streamlined and efficient mortality prediction model for AP.

Methods: This study focused on all-cause mortality 30 days after ICU admission using data from eligible AP patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Multiple clinical indicators were used to construct 10 ratios, including the lactate-to-calcium ratio (LCR). The study analyzed the relationship between these 10 ratios as well as commonly used clinical indicators and mortality rates, developed a predictive model for 30-day mortality, and evaluated the model’s predictive performance. External validation was performed on an independent AP cohort extracted from the eICU Collaborative Research Database (eICU-CRD).

Results: This study included 680 patients with AP, among whom the mortality rate was 14.9%. The LCR and other biomarker ratios demonstrated significant predictive capacity for mortality risk. The final model incorporating LCR with five routine parameters exhibited good calibration, showing strong agreement between predicted and observed outcomes. This model demonstrated good predictive performance, comparable to conventional clinical scoring systems. Decision curve analysis revealed superior clinical utility of this model. External validation confirmed our streamlined model’s comparable predictive performance and clinical utility to conventional clinical scores.

Conclusion: The LCR was an independent significant risk factor for the 30-day all-cause mortality rate in AP patients. Compared to conventional clinical scoring systems, our model achieves equally good discriminative performance using fewer and more readily available parameters, while also demonstrating favorable clinical decision-making value, thereby exhibiting greater practical utility in critical care practice.