Ma Yuanji, Du Lingyao, Bai Lang, Tang Hong
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
Eur J Gastroenterol Hepatol. 2025 Mar 1;37(3):327-336. doi: 10.1097/MEG.0000000000002885. Epub 2025 Jan 29.
The impact of lactate-to-albumin ratio (LAR) on the outcome of acute-on-chronic liver failure (ACLF) is scant.
To investigate the relationship between LAR and short-term prognosis in patients with COSSH (Chinese Group on the Study of Severe Hepatitis B) ACLF.
A retrospective cohort study was conducted in patients with COSSH ACLF treated with an artificial liver support system. Restricted cubic splines, linear regression models, and Cox regression models were used to investigate the relationships of LAR with disease severity and 28-day prognosis.
The 28-day transplant-free and overall survival rates in the 258 eligible patients were 76.4% and 82.2%, respectively. The LAR in 28-day transplant-free survivors was lower than that in transplant or death patients [0.74 (0.58-0.98) vs. 1.03 (0.79-1.35), P < 0.001]. The LAR was positively associated with disease severity, 28-day transplant-free survival [adjusted hazard ratio (HR) (95% confidence interval (CI)) for transplant or death: 2.18 (1.37-3.46), P = 0.001], and overall survival [adjusted HR (95% CI) for death: 2.14 (1.21-3.80), P = 0.009]. Compared with patients with LAR < 1.01, patients with LAR ≥ 1.01 had poor 28-day prognosis [all adjusted HR (95% CI) > 1, P < 0.05]. Lactate was not a potential modifier of the relationship between LAR and short-term prognosis.
LAR was positively associated with disease severity and poor short-term prognosis in patients with COSSH ACLF.
乳酸与白蛋白比值（LAR）对慢加急性肝衰竭（ACLF）预后的影响尚不清楚。
探讨中国重型乙型肝炎研究组（COSSH）ACLF患者中LAR与短期预后的关系。
对接受人工肝支持系统治疗的COSSH ACLF患者进行回顾性队列研究。采用受限立方样条、线性回归模型和Cox回归模型研究LAR与疾病严重程度及28天预后的关系。
258例符合条件的患者中，28天无移植生存率和总生存率分别为76.4%和82.2%。28天无移植生存患者的LAR低于接受移植或死亡患者[0.74（0.58 - 0.98）对1.03（0.79 - 1.35），P < 0.001]。LAR与疾病严重程度、28天无移植生存[移植或死亡的调整风险比（HR）（95%置信区间（CI））：2.18（1.37 - 3.46），P = 0.001]和总生存[死亡的调整HR（95% CI）：2.14（1.21 - 3.80），P = 0.009]呈正相关。与LAR < 1.01的患者相比，LAR≥1.01的患者28天预后较差[所有调整HR（95% CI）>1，P < 0.05]。乳酸不是LAR与短期预后关系的潜在调节因素。
在COSSH ACLF患者中，LAR与疾病严重程度及不良短期预后呈正相关。
