Association of the Lactate-to-Albumin Ratio With All-Cause Mortality in Trauma and Surgical Intensive Care Patients:...

The lactate-to-albumin ratio (LAR) has emerged as a novel prognostic biomarker in acute pancreatitis, septic shock, acute respiratory distress syndrome, and cardiac arrest. However, the prognostic utility of the LAR for all-cause mortality (ACM) in critically ill surgical/trauma patients remains unevaluated.

Patients in surgical/trauma surgical intensive care unit (SICU/TSICU) were identified through the Medical Information Mart for Intensive Care-IV database. The Boruta feature selection algorithm was implemented to identify predictors significantly associated with ACM, Cox proportional hazards regression models and Restricted cubic splines were employed to evaluate the nonlinear association between the LAR and ACM, while Kaplan-Meier survival curves were generated to visualize temporal survival differences.

This study enrolled 2838 patients in TSICU and SICU. Multivariable Cox proportional hazards regression demonstrated the LAR was associated with 90-d and 1-y ACM in patients admitted to the SICU/TSICU. Restricted cubic splines regression revealed a dose-dependent increase in ACM risk with escalating LAR levels. A nonlinear relationship between LAR and 90-d and 1-y ACM was identified, with an inflection point of 0.79 (P < 0.001). Consistently, LAR ≥ 0.79 was associated with increased risks of 90-d (hazard ratio 1.52, 95% confidence interval 1.28 ∼ 1.80) and 1-y (hazard ratio 1.37, 95% confidence interval 1.18 ∼ 1.59) ACM.

In summary, a correlation was observed between the LAR and ACM in SICU and TSICU patients. Future validation in prospective, multicenter cohorts is essential before any consideration can be given to its application in clinical practice.