Lactate-to-albumin ratio as a potential prognostic predictor in patients with cirrhosis and sepsis: a retrospective cohort study

Abstract

Background: Patients with liver cirrhosis face high infection risks due to immune dysfunction and hospital-related factors, increasing mortality rates when sepsis occurs. While various biomarkers predict outcomes in cirrhosis, few are accessible and reliable. This study addresses the gap by evaluating the prognostic potential of the lactate-to-albumin ratio (LAR).

Methods: We retrospectively analyzed data from patients with cirrhosis and sepsis who were admitted to the intensive care unit at Beth Israel Deaconess Medical Center between 2008 and 2022. LAR was calculated from the ratio obtained from the first measurement taken within 24 h of admission. The optimal LAR threshold was determined using R statistical software. Kaplan-Meier analysis was used to compare mortality risks between two patient groups, while multivariate Cox proportional hazards regression models were used to assess the association between LAR and mortality risk in patients with cirrhosis and concomitant sepsis. A restricted cubic spline (RCS) was used to explore potential dose-response relationships between LAR and mortality. Receiver operating characteristic (ROC) analyses were used to assess the predictive ability, sensitivity, and specificity of LAR for all-cause mortality in patients with cirrhosis and combined sepsis, and the area under the curve (AUC) was calculated. Finally, subgroup analyses were performed to assess the relationship between LAR and prognosis across different populations.

Results: A total of 1731 patients were included in the study. The optimal LAR threshold was identified as 1.0 using R statistical software. Kaplan-Meier analysis indicated that patients with higher LAR levels had a higher risk of 14-day, 28-day, and 90-day all-cause mortality (all log-rank P < 0.001). Multivariate Cox proportional hazards models indicated independent associations between higher LAR levels and all-cause mortality at 14-day, 28-day, and 90-day before and after adjusting for confounders. RCS analysis revealed a nonlinear association between LAR and short- and long-term all-cause mortality in patients with cirrhosis and sepsis. ROC curve analysis showed that although the predictive value of LAR for the prognosis of patients with cirrhosis combined with sepsis was slightly inferior to that of the Model for End-Stage Liver Disease score, it was significantly better than that of lactate, albumin, and the Sequential Organ Failure Assessment. Subgroup analyses showed no significant interactions between LAR and any specific subgroup.

Conclusion: LAR has good predictive value for the prognosis of patients with cirrhosis and sepsis.

Keywords: Cirrhosis; Lactate to albumin ratio; Model for end-stage liver disease score; Prognosis; Sepsis; Sequential organ failure assessment.

Fig. 1

Flowchart for participants from MIMIV-IV (v 3.0)

Fig. 2

Kaplan–Meier curves and cumulative incidence of 14-day (A), 28-day (B), and 90-day (C) all-cause mortality stratified by LAR groups

Fig. 3

Restricted cubic spline regression analysis of LAR with 14-day (A), 28-day (B), and 90-day (C) all-cause mortality in patients with cirrhosis and combined sepsis. 14-day all-cause mortality: P for no-linear < 0.001; 28-day all-cause mortality: P for no-linear < 0.001; 90-day all-cause mortality: P for no-linear < 0.001

Fig. 4

Receiver operating characteristic curves assesses the predictive capability of the LAR index for 14-day (A), 28-day (B), and 90-day (C) all-cause mortality

Fig. 5

Forest plots of stratified analyses of LAR (continuous) and 14-day (A), 28-day (B), and 90-day all-cause mortality in patients with cirrhosis and combined sepsis