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Updated: Aug 6, 2026
Identification and Quantification of Deranged Metabolites in Critically Ill Patients Using NMR-Based Metabolomics
Published on: November 29, 2024
Association between serum lactate/albumin ratio and all-cause mortality in critically ill patients: a meta-analysis
Xinwei Liu1, Xiulin Xie2, Chen Zhao3
1Department of Critical Care Medicine, The Second Xiangya Hospital of Central South University, Changsha City, Hunan Province, China.
Background:
The serum lactate/albumin ratio (LAR) is a low-cost prognostic biomarker in intensive care. Although elevated LAR has been linked to poor outcomes in sepsis, heart failure, and acute kidney injury, existing studies are limited by heterogeneous populations and inconsistent cut-off values.
Purpose:
To evaluate the association between LAR and short- and long-term all-cause mortality, and its diagnostic accuracy for mortality prediction, in critically ill adults.
Study Type:
Systematic review and meta-analysis of observational studies, conducted following PRISMA guidelines and registered with PROSPERO (CRD420251055330).
Population:
Twenty-nine observational studies comprising 39,681 critically ill adults identified from PubMed, Embase, Cochrane Library, and Web of Science through February 18, 2025.Assessment techniques/outcomes:LAR was calculated as serum lactate divided by albumin within 24 hours of intensive care unit (ICU) admission. Outcomes were short-term and long-term all-cause mortality and diagnostic accuracy. Quality was appraised using the Quality Assessment of Prognostic Accuracy Studies (QUAPAS) tool and the Newcastle-Ottawa Scale (NOS).
Statistical Tests:
Hazard ratios (HR) with 95% confidence intervals (CI) were pooled using fixed- or random-effects models according to heterogeneity (I2). Diagnostic accuracy was synthesized using a bivariate mixed-effects model, with summary receiver operating characteristic (SROC) area under the curve (AUC) estimated. Evidence certainty was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
Results:
Elevated LAR was associated with increased short-term (HR 2.63, 95% CI 2.27-3.04; 9 studies, 15,772 patients) and long-term mortality (HR 2.21, 1.70-2.86; 8 studies, 11,372 patients). Pooled sensitivity, specificity, and AUC were 0.71, 0.74, and 0.78, respectively (24 studies, 32,453 patients). Subgroup analyses confirmed stability across countries, data sources, diseases, and measurement timings. QUAPAS indicated overall low-to-moderate risk of bias; NOS scores ranged 7-9. GRADE certainty was high for short-term mortality and low for long-term mortality and diagnostic accuracy.
Data Conclusion:
Elevated LAR is independently associated with increased short- and long-term mortality in critically ill patients, with moderate diagnostic accuracy. LAR may complement existing scoring systems for early risk stratification, pending prospective validation and standardized cut-offs.