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Machine Learning-Augmented Traditional Analysis of Lactate vs Lactate-to-Albumin Ratio for Predicting Mortality Risk
Xiaodi Wang1, Yi Xu2, Weijun Xiao3
1Department of Neurology, Clinical Neuroscience Center, the 7th Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, China.
JMIR Medical Informatics
|July 16, 2026
Summary
The lactate-to-albumin ratio (LAR) better predicts 28-day sepsis mortality than lactate alone in ICU patients. LAR offers improved prognostic utility, especially for those without severe hyperlactatemia, aiding early risk stratification.
Area of Science:
- Critical care medicine
- Biomarker research
- Sepsis prognostication
Background:
- Sepsis risk stratification is challenging; serum lactate has limitations.
- The lactate-to-albumin ratio (LAR) combines metabolic and inflammatory markers.
- LAR's incremental value over lactate needed validation in a large cohort.
Purpose of the Study:
- To compare the predictive performance of LAR versus lactate for 28-day sepsis mortality.
- To utilize advanced statistical methods and machine learning for robust analysis.
- To assess LAR's prognostic utility in diverse sepsis patient subgroups.
Main Methods:
- Retrospective analysis of 3637 adult sepsis patients from the eICU Collaborative Research Database.
- Primary outcome: 28-day all-cause in-hospital mortality.
- Methods included logistic regression, Cox regression, threshold analysis, restricted cubic splines, DeLong test, and 9 machine learning models with SHAP for interpretability.
Main Results:
- LAR showed significantly higher discrimination for 28-day mortality than lactate (AUC 0.646 vs 0.617).
- Machine learning models, particularly logistic regression, random forest, and GBDT, demonstrated strong predictive capabilities.
- LAR was identified as a top predictive feature in several machine learning models.
Conclusions:
- LAR provides statistically significant higher discrimination for predicting 28-day sepsis mortality compared to lactate alone.
- LAR may be particularly valuable for risk stratifying sepsis patients without severe hyperlactatemia.
- Further prospective validation is warranted for LAR's prognostic effects, especially in lower-severity patients.