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The following is a summary of “Nonlinear association between hematocrit levels and short-term all-cause mortality in ICU patients with acute pancreatitis: insights from a retrospective cohort study,” published in the March 2025 issue of the BMC Gastroenterology by Zou et al.

This study aimed to evaluate the association between hematocrit (HCT) levels and mortality risk in patients with acute pancreatitis (AP) admitted to the intensive care unit (ICU), given the limited existing research on this relationship. Clinical data were extracted from the Medical Information Mart for Intensive Care database for patients diagnosed with AP. The association between HCT levels and patient prognosis was assessed using Locally Estimated Scatterplot Smoothing (LOESS) regression, restricted cubic splines (RCS), and U-test analyses to identify potential nonlinear relationships. 

The impact of HCT levels on mortality risk was further examined through a binomial generalized linear model with a logit link, adjusting for potential confounders. A total of 1,914 patients with AP were included in the analysis, revealing a significant difference in HCT levels between survivors and non-survivors (33.6 [29.5–38.1] vs. 32.1 [28.1–37.4], P < 0.001). Logistic regression models demonstrated that HCT was an independent predictor of mortality in both univariate and multivariate analyses (all P < 0.05). The results of LOESS regression, RCS analysis, and the U-test identified a U-shaped relationship between HCT levels and 28-day mortality, indicating that both elevated and decreased HCT levels correlated with increased mortality risk (P for overall < 0.001). 

Further, stratification into tertiles showed that patients with lower HCT levels (<30.8%) exhibited a significantly higher risk of 28-day mortality (Crude model: [OR] 1.665, 95% [CI] 1.198–2.314; fully adjusted model: adjusted OR 1.474, 95% CI 1.005–2.161; all P < 0.05). Additionally, survival analyses reinforced the adverse prognosis linked to reduced HCT levels. The findings suggest that, despite the observed U-shaped association, only lower HCT levels were identified as a significant independent risk factor for 28-day mortality in critically ill patients with AP. These results highlight the potential prognostic value of monitoring HCT levels in ICU patients with AP and emphasize the need for further research to explore potential interventions targeting HCT-related risk factors.

Source: bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-025-03764-8