Prognostic value of the lactate-to-albumin ratio in critically ill chronic heart failure patients with sepsis: insights from a retrospective cohort study

Abstract

Background and objectives: Critically ill patients with chronic heart failure (CHF) complicated with sepsis are associated with a high mortality risk. The lactate-to-albumin ratio (LAR) has been shown to correlate with poor prognosis in various critical illnesses. However, the relationship between LAR and the short-and long-term prognosis of critically ill patients with CHF and sepsis has not been thoroughly explored. Therefore, this study aimed to evaluate the prognostic value of LAR in critically ill patients with CHF and sepsis.

Methods: A retrospective analysis was conducted on the clinical data of 2,416 ICU-managed critically ill patients with CHF and sepsis. Based on the optimal cutoff value, patients were divided into higher LAR and lower LAR groups. Multivariable Cox proportional hazards models were used to assess the association between LAR and all-cause mortality at different time points (ICU, in-hospital, 14-day, 28-day, and 90-day). Kaplan-Meier survival curves were used to evaluate the differences in all-cause mortality risk between the two groups. The receiver operating characteristic (ROC) curve is used to evaluate the predictive ability, sensitivity, specificity, and area under the curve (AUC) of LAR for predicting in-hospital mortality in patients with CHF and sepsis. Restricted cubic spline (RCS) analysis was performed to examine the potential dose-response relationship between LAR and all-cause mortality at each time point. Subgroup analyses further explored the impact of patient characteristics on the prognostic value of LAR.

Results: LAR was significantly associated with ICU, in-hospital, 14-day, 28-day, and 90-day all-cause mortality. The higher LAR group had a higher risk of death compared to the lower LAR group (all p < 0.001). Cox regression analysis confirmed that LAR was an independent prognostic factor for ICU, in-hospital, 14-day, 28-day, and 90-day all-cause mortality in critically ill patients with CHF and sepsis. Kaplan-Meier survival curves further confirmed the significant association between LAR and poor prognosis. The ROC curve analysis shows that LAR has a better predictive value for the prognosis of patients with CHF and sepsis compared to lactate and albumin. RCS analysis demonstrated a linear relationship between LAR and ICU, in-hospital, 14-day, 28-day, and 90-day all-cause mortality. Subgroup analyses revealed consistent prognostic effects of LAR across different clinical subgroups, with no significant interaction observed.

Conclusion: LAR is an independent predictor of short-term and long-term all-cause mortality in critically ill patients with CHF and sepsis. LAR has the potential to serve as a valuable prognostic biomarker in this population, providing significant implications for clinical decision-making and patient management.

Keywords: chronic heart failure; lactate-to-albumin ratio; prognostic biomarker; retrospective cohort study; sepsis.

Figure 1

Flowchart for participants from MIMIC-IV (v 3.0).

Figure 2

The choice of the optimal cutoff point maximized the risk ratio and the relationship between LAR ≥ 0.63 and the distribution of LAR.

Figure 3

Kaplan–Meier survival analysis curves for all-cause mortality. Kaplan–Meier curves and cumulative incidence of ICU (A), In-hospital (B), 14-day (C), 28-day (D), and 90-day (E) all-cause mortality stratified by LAR groups.

Figure 4

Receiver operating characteristic curves assesses the predictive capability of the LAR for ICU (A), In-hospital (B), 14-day (C), 28-day (D), and 90-day (E) all-cause mortality.

Figure 5

Restricted cubic spline regression analysis of LAR with all-cause mortality. Restricted cubic spline regression analysis of LAR with ICU (A), In-hospital (B), 14-day (C), 28-day (D), and 90-day (E) all-cause mortality. ICU mortality: P for overall-linear < 0.001. In-hospital mortality: P for overall-linear < 0.001. 14-day all-cause mortality: P for overall-linear = 0.01.28-day all-cause mortality: P for overall-linear < 0.001.90-day all-cause mortality: P for overall-linear < 0.001.

Figure 6

Forest plots of stratified analyses of LAR and ICU (A), In-hospital (B), 14-day (C), 28-day (D), and 90-day (E) all-cause mortality.