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Association between lactate-to-albumin ratio and all-cause mortality in critically ill hepatic failure patients with sepsis: A retrospective cohort study

Year: 2026

Type: article

Abstract: Hepatic failure complicated by sepsis is a highly lethal condition with an extremely high fatality rate. The lactate-to-albumin ratio (LAR) has been identified as a predictor of adverse outcomes in various diseases. However, the prognostic value of LAR in critically ill hepatic failure patients with sepsis remains to be defined. Participants were selected from the Medical Information Mart for Intensive Care-IV database and categorized into tertiles according to the LAR index. The primary outcomes were 30-day and 365-day all-cause mortality. Kaplan-Meier survival analysis was performed to visualize survival differences across tertiles. Cox proportional hazards regression and restricted cubic spline (RCS) models were employed to characterize the relationship between the LAR index and all-cause mortality; subgroup analyses were conducted to explore potential interactions. A total of 1346 patients were included; all-cause mortality rates at 30, 90, 180, and 365 days were 43.16%, 53.05%, 55.72%, and 58.99%, respectively. Kaplan-Meier curves confirmed that survival at 30, 90, 180, and 365 days decreased significantly across increasing LAR tertiles. Adjusted multivariable Cox regression showed that, compared with the lowest tertile, the highest LAR tertile had an 84% higher 30-day mortality risk (hazard ratio [HR] = 1.84; 95% confidence interval [CI]: 1.43-2.36; P < .001) and a 63% higher 365-day mortality risk (HR = 1.63; 95% CI: 1.32-2.01; P < .001). RCS analysis verified a positive, nonlinear association between the LAR index and all-cause mortality at 30, 90, 180, and 365 days (all nonlinear P < .001). Subgroup analysis indicated a stronger association between LAR and mortality in non-elderly patients. In critically ill hepatic failure patients with sepsis, elevated LAR is independently associated with increased all-cause mortality. This highlights the potential of LAR as a key prognostic biomarker for risk stratification and management of hepatic failure patients with sepsis in the intensive care unit.

Source: Medicine

DOI: 10.1097/md.0000000000049123