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. 2025 Jun 13;44(3):453-469.
doi: 10.5937/jomb0-54979.

Association between lactate-to-albumin ratio and shortand long-term mortality in critically ill patients with ischemic stroke: A retrospective analysis of the MIMIC-IV database

Sisi Qin  1 , Jijie Xiao  2 , Shiqi Yuan  3 , Huitao Zhang  1 , Yang Liu  1 , Ningjun Li  1 , Songjin He  1 , Li Kou  4
Affiliations

Association between lactate-to-albumin ratio and shortand long-term mortality in critically ill patients with ischemic stroke: A retrospective analysis of the MIMIC-IV database

Sisi Qin et al. J Med Biochem. .

Abstract
in English, Serbian

Background: Stroke is a major cause of disability and cognitive deficits, with ischemic stroke (IS) being the most prevalent type, especially in critically ill patients in intensive care units (ICUs). The lactate-to-albumin ratio (LAR) has emerged as a potential predictor of disease outcomes, but its association with shortand long-term mortality in critically ill IS patients is unclear.

Methods: This study analyzed data from 894 critically ill IS patients from the MIMIC-IV database, categorized into LAR tertiles. Clinical endpoints included ICU, hospital, and 30and 90-day all-cause mortality. Survival differences were assessed using Kaplan-Meier analysis. Cox proportional-hazards regression models and restricted cubic spline (RCS) analysis evaluated the association between LAR and mortality outcomes. Subgroup analyses examined the modifying effects of clinical characteristics on LAR's predictive value.

Results: The ICU, hospital, 30-, and 90-day mortality rates were 15.0%, 22.3%, 28.2%, and 36.1%, respectively. Higher LAR levels were associated with reduced survival times and increased mortality risks in all endpoints. Multivariable Cox models confirmed LAR as an independent predictor of 30and 90-day mortality. RCS analysis indicated a linear relationship between LAR and ICU mortality (P = 0.109), and a non-linear association with hospital (P = 0.005), 30-day (P < 0.001), and 90-day mortality (P < 0.001). Subgroup analyses highlighted significant interactions for respiratory failure and GCS.

Conclusions: LAR is a robust predictor of shortand longterm mortality in critically ill IS patients, offering clinicians a valuable tool for risk stratification and decision-making.

Uvod: Moždani udar je glavni uzrok invaliditeta i kognitivnih deficita, pri čemu je ishemijski moždani udar (IS) najčešći tip, posebno kod kritično bolesnih pacijenata u jedinicama intenzivne nege (ICU). Odnos laktata i albumina (LAR) se pojavio kao potencijalni prediktor ishoda bolesti, ali njegova povezanost sa kratkoročnim i dugoročnim mortalitetom kod kritično bolesnih pacijenata sa IS nije jasna.

Metode: Ova studija je analizirala podatke od 894 kritično bolesna pacijenata sa IS iz baze podataka MIMIC-IV, kategorisane u LAR tertile. Kliničke krajnje tačke uključivale su intenzivnu negu, bolničku smrtnost i smrtnost od svih uzroka tokom 30 i 90 dana. Razlike u preživljavanju su procenjene primenom Kaplan-Meier analize. Koksovi regresijski modeli proporcionalnih opasnosti i analiza ograničenog kubnog splaj na (RCS) procenili su povezanost između LAR-a i ishoda mortaliteta. Analize podgrupa ispitivale su modifikacione efekte kliničkih karakteristika na prediktivnu vrednost LAR-a.

Rezultati: Intenzivna intenzivnost, bolnička stopa mortaliteta 30 i 90 dana iznosila je 15,0%, 22,3%, 28,2% i 36,1% respektivno. Viši nivoi LAR-a bili su povezani sa skraćenim vremenom preživljavanja i povećanim rizikom od smrtnosti u svim krajnjim tačkama. Multivarijabilni Cok modeli potvrdili su LAR kao nezavisni prediktor mortaliteta od 30 i 90 dana. RCS analiza je pokazala linearnu vezu između mortaliteta LAR i intenzivne nege (P = 0,109) i nelinearnu povezanost sa bolničkim (P = 0,005), 30-dnevnim (P < 0,001) i 90-dnevnim mortalitetom (P < 0,001). Analize podgrupa su istakle značajne interakcije za respiratornu insuficijenciju i GCS.

Zaključak: LAR je snažan prediktor kratkoročne i dugotrajne smrtnosti kod kritično bolesnih pacijenata sa IS, nudeći kliničarima dragoceno sredstvo za stratifikaciju rizika i donošenje odluka.

Keywords: MIMIC-IV Database; ischemic stroke; lactate-to-albumin ratio; mortality.

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Conflict of interest statement

All the authors declare that they have no conflict of interest in this work.Conflict of Interest: The authors stated that they have no conflicts of interest regarding the publication of this article.

Figures

Figure 1
Figure 1. Flow of included patients through the trial.
Figure 2
Figure 2. Kaplan–Meier curves of the ICU, Hospital, 30- and 90-day all-cause mortality by LAR tertiles.
Figure 3
Figure 3. Restricted cubic spline curve illustrating the relationship between LAR and ICU, hospital, 30- and 90-day all-cause mortality. The vertical dotted lines represent LAR 0.56, selected as the reference level.
See this image and copyright information in PMC

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