Title: Association Between Albumin-Corrected Anion Gap and Delirium in Acute Pancreatitis:
Insights from the MIMIC-IV Database
Version: 1 Date: 13 Jun 2025
Reviewer's report:
The authors present findings of retrospective analysis of the MIMIC-IV database the goal of
examining the association between albumin-corrected anion gap (ACAG) and delirium at any
point during a hospitalization in patients with acute pancreatitis.  A biomarker for delirium in
this population would indeed be of interest. I think this is what the authors are stating but it
remains very unclear currently.  I have a few broad questions about this manuscript that warrant
addressing.
First, at one time point was the ACAG assessed?  Within 24 hours of ICU admission? At any
point in the hospitalization?  If it is within the first 24 hours of ICU admission, and this value
is associated with development of delirium at any point during an ICU admission for AP, then
this would indeed be an intriguing biomarker.  This needs to be clarified, and I would suggest
mentioning it in the last paragraph of the introduction if this is the case.
Further, the primary outcome needs clarification.  What is meant, specifically, by risk of delirium
within 28 days of hospitalization?  Does this mean occurrence of delirium at any time point up to
28 days after a hospitalization for AP?  If so, one would need at least daily delirium assessments
for this outcome.  Does this this dataset contain this degree of data?  If so, who performed the
CAM’s?  Was it nurses or research team members?
I am also assuming that this dataset does not have post hospitalization delirium assessments.   If
so, please clarify that outcomes assessments were censored at time of hospital discharge.
Within the data collection section, please clarify the CAM-scale used.  Was it the CAM-ICU,
3D-CAM, other?  Was delirium defined as a positive result on these tests at any time during
hospitalization?
One other small point/ query:  Does this database include surgical ICU admissions, medical or
both?
Overall, again, I think the authors are trying to state that ACAG collected within 24 hours
of ICU admission is predictive of delirium occurrence at any point during hospitalization. If
this is correct, I would strongly encourage the authors to clarify their language to reflect this
finding with specific attention to the time frame of both the exposure (ACAG) and the outcome
(delirium).
Title: Association Between Albumin-Corrected Anion Gap and Delirium in Acute Pancreatitis:
Insights from the MIMIC-IV Database
Version: 1 Date: 13 Jun 2025
Reviewer's report:
The authors present findings of retrospective analysis of the MIMIC-IV database the goal of
examining the association between albumin-corrected anion gap (ACAG) and delirium at any
point during a hospitalization in patients with acute pancreatitis.  A biomarker for delirium in
this population would indeed be of interest. I think this is what the authors are stating but it
remains very unclear currently.  I have a few broad questions about this manuscript that warrant
addressing.
First, at one time point was the ACAG assessed?  Within 24 hours of ICU admission? At any
point in the hospitalization?  If it is within the first 24 hours of ICU admission, and this value
is associated with development of delirium at any point during an ICU admission for AP, then
this would indeed be an intriguing biomarker.  This needs to be clarified, and I would suggest
mentioning it in the last paragraph of the introduction if this is the case.
Further, the primary outcome needs clarification.  What is meant, specifically, by risk of delirium
within 28 days of hospitalization?  Does this mean occurrence of delirium at any time point up to
28 days after a hospitalization for AP?  If so, one would need at least daily delirium assessments
for this outcome.  Does this this dataset contain this degree of data?  If so, who performed the
CAM’s?  Was it nurses or research team members?
I am also assuming that this dataset does not have post hospitalization delirium assessments.   If
so, please clarify that outcomes assessments were censored at time of hospital discharge.
Within the data collection section, please clarify the CAM-scale used.  Was it the CAM-ICU,
3D-CAM, other?  Was delirium defined as a positive result on these tests at any time during
hospitalization?
One other small point/ query:  Does this database include surgical ICU admissions, medical or
both?
Overall, again, I think the authors are trying to state that ACAG collected within 24 hours
of ICU admission is predictive of delirium occurrence at any point during hospitalization. If
this is correct, I would strongly encourage the authors to clarify their language to reflect this
finding with specific attention to the time frame of both the exposure (ACAG) and the outcome
(delirium).
Please review this paper.
user
Title: Association Between Albumin-Corrected Anion Gap and Delirium in Acute Pancreatitis:
Insights from the MIMIC-IV Database
Version: 1 Date: 13 Jun 2025
Reviewer's report:
The authors present findings of retrospective analysis of the MIMIC-IV database the goal of
examining the association between albumin-corrected anion gap (ACAG) and delirium at any
point during a hospitalization in patients with acute pancreatitis.  A biomarker for delirium in
this population would indeed be of interest. I think this is what the authors are stating but it
remains very unclear currently.  I have a few broad questions about this manuscript that warrant
addressing.
First, at one time point was the ACAG assessed?  Within 24 hours of ICU admission? At any
point in the hospitalization?  If it is within the first 24 hours of ICU admission, and this value
is associated with development of delirium at any point during an ICU admission for AP, then
this would indeed be an intriguing biomarker.  This needs to be clarified, and I would suggest
mentioning it in the last paragraph of the introduction if this is the case.
Further, the primary outcome needs clarification.  What is meant, specifically, by risk of delirium
within 28 days of hospitalization?  Does this mean occurrence of delirium at any time point up to
28 days after a hospitalization for AP?  If so, one would need at least daily delirium assessments
for this outcome.  Does this this dataset contain this degree of data?  If so, who performed the
CAM’s?  Was it nurses or research team members?
I am also assuming that this dataset does not have post hospitalization delirium assessments.   If
so, please clarify that outcomes assessments were censored at time of hospital discharge.
Within the data collection section, please clarify the CAM-scale used.  Was it the CAM-ICU,
3D-CAM, other?  Was delirium defined as a positive result on these tests at any time during
hospitalization?
One other small point/ query:  Does this database include surgical ICU admissions, medical or
both?
Overall, again, I think the authors are trying to state that ACAG collected within 24 hours
of ICU admission is predictive of delirium occurrence at any point during hospitalization. If
this is correct, I would strongly encourage the authors to clarify their language to reflect this
finding with specific attention to the time frame of both the exposure (ACAG) and the outcome
(delirium).
assistant