Risk analysis of the association between lactate-to-hematocrit ratio and poor prognosis in critical patients with...

Liver cirrhosis contributes substantially to global health and causes high mortality in critically ill patients. While the lactate-to-hematocrit ratio (LHR) has established prognostic value in diverse critical illnesses, its utility in critically ill cirrhotic patients remains underexplored. This study evaluated the role of LHR in predicting short- and long-term outcomes in this distinct clinical cohort. This retrospective study analyzed cirrhotic patients using the MIMIC-IV database. LHR was derived from initial arterial blood lactate (LAC) and hematocrit (HCT) measurements. Participants were stratified by LHR quartiles, with 30-day all-cause mortality as the primary endpoint and 180-/365-day mortality as secondary endpoints. The associations between LHR and mortality were assessed using Kaplan-Meier survival analysis and multivariable Cox regression models. Further determine whether there is a linear relationship using restricted cubic spline (RCS) curves. Finally, subgroup analyses were conducted to assess the consistency of the LHR-prognosis relationship across various patient subsets. In a cohort of 2998 critically ill cirrhotic patients, elevated LHR was strongly associated with increased mortality at 30, 180 and 365 days. Compared to the lowest quartile, patients in the highest LHR quartile had a 144.2% higher risk of 30-day mortality (hazard ratio [HR] = 2.442, 95% confidence interval [CI]: 1.951-3.057), a 139.6% higher risk at 180 days (HR = 2.396, 95% CI: 1.95-2.944) and a 139.1% higher risk at 365 days (HR = 2.391, 95% CI: 1.955-2.925). Kaplan-Meier survival analysis revealed significantly worse outcomes for patients with higher LHR at all time points (log-rank P < .001). Additionally, restricted cubic splines analysis showed a significant nonlinear relationship between LHR and both short- and long-term mortality risk. Subgroup analyses revealed that the association between LHR and mortality was heterogeneous across specific patient characteristics, with significant interactions observed particularly in those with spontaneous bacterial peritonitis and those using glucocorticoids. LHR is an independent predictor of short- and long-term all-cause mortality in critically ill cirrhotic patients. Given its simplicity and availability from routinely measured parameters, integrating LHR into early clinical assessment may facilitate timely risk stratification and support clinical decision-making in the intensive care unit.