Wu Huan, Wu Long, Luo Li, Li Hai-Yang, Zhang Bao-Fang
Department of Infectious Diseases, The Affiliated Hospital of Guizhou Medical University, No.28 Guiyi Street, Yunyan District, Guiyang City, Guizhou Province, China.
Department of Anus and Intestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China.
BMC Infect Dis. 2025 Mar 28;25(1):433. doi: 10.1186/s12879-025-10783-z.
Liver failure has a high mortality rate, and currently, there is no convenient risk predictor. The lactate-to-albumin ratio (LAR) has emerged as a promising predictor in various critical illnesses. However, its potential role in predicting all-cause mortality in patients with liver failure remains unexplored. Therefore, this study aims to investigate the correlation between LAR and all-cause mortality in patients suffering from liver failure.
We retrospectively analyzed data from patients with liver failure who were admitted to the intensive care unit (ICU) between 2008 and 2019, which were gathered from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. LAR was calculated from the ratio obtained from the first measurement taken within 24 h of admission. The optimal LAR threshold was determined using the Youden index. With LAR categorized into low, middle, and high groups based on tertiles, Kaplan - Meier analysis was employed to compare mortality risks among three patient groups. Multivariate Cox proportional hazards regression models were utilized to evaluate the association between LAR and all-cause mortality in hepatic failure patients within hospital admission. Additionally, receiver operating characteristic (ROC) and smoothing curve analysis were used to assess the predictive ability, sensitivity, and specificity of LAR for all-cause mortality in patients with liver failure, and the area under the curve (AUC) was calculated. A smooth curve fitting approach and threshold effect analysis were employed to detect the potentially non-linear relationship between the LAR and the risk of all-cause mortality in patients with hepatic failure. Finally, subgroup analyses were performed to assess the relationship between LAR and prognosis across different types of liver failure.
A total of 902 patients with hepatic failure were included in this study. They were divided into survivors group (611 patients) and non-survivors group (291 patients) according to whether they survived during hospitalization, and the mortality rate of patients was 32.26%. The Kaplan-Meier survival curves illustrating patients in hepatic failure with elevated LAR showed a significantly heightened risk of in-hospital mortality (P < 0.001). We identified a non-linear relationship between LAR and the risk of hospital mortality after adjusting for potential confounders and the inflection point of LAR to be 1.33. LAR was shown to be an independent predictor of all-cause mortality within hospitalization in patients with hepatic failure by multivariate COX regression analysis (HR, 1.66; 95% CI, 1.35-2.05; P < 0.0001). The optimal cutoff value for separating the survival and death groups according to ROC was found to be 0.97. The AUC value for LAR was 0.755 (95% CI: 0.721, 0.789), which was higher than that for arterial blood lactate (AUC = 0.725) and serum albumin (AUC = 0.680) alone. It was not inferior even when compared to MELD (AUC = 0.677).
LAR has demonstrated good predictive value for all-cause mortality among liver failure patients in our retrospective study.
肝衰竭死亡率高，目前尚无便捷的风险预测指标。乳酸与白蛋白比值（LAR）已成为多种危重病中有前景的预测指标。然而，其在预测肝衰竭患者全因死亡率方面的潜在作用仍未得到探索。因此，本研究旨在探讨LAR与肝衰竭患者全因死亡率之间的相关性。
我们回顾性分析了2008年至2019年入住重症监护病房（ICU）的肝衰竭患者的数据，这些数据来自重症监护医学信息集市IV（MIMIC-IV）数据库。LAR根据入院后24小时内首次测量所得比值计算得出。使用约登指数确定最佳LAR阈值。根据三分位数将LAR分为低、中、高组，采用Kaplan-Meier分析比较三组患者的死亡风险。采用多变量Cox比例风险回归模型评估LAR与肝衰竭患者入院期间全因死亡率之间的关联。此外，使用受试者工作特征（ROC）和平滑曲线分析评估LAR对肝衰竭患者全因死亡率的预测能力、敏感性和特异性，并计算曲线下面积（AUC）。采用平滑曲线拟合方法和阈值效应分析检测LAR与肝衰竭患者全因死亡风险之间潜在的非线性关系。最后，进行亚组分析以评估LAR与不同类型肝衰竭患者预后之间的关系。
本研究共纳入902例肝衰竭患者。根据住院期间是否存活分为存活组（611例患者）和非存活组（291例患者），患者死亡率为32.26%。显示LAR升高的肝衰竭患者的Kaplan-Meier生存曲线表明住院死亡率风险显著增加（P < 0.001）。在调整潜在混杂因素后，我们发现LAR与医院死亡风险之间存在非线性关系，LAR的拐点为1.33。多变量COX回归分析显示LAR是肝衰竭患者入院期间全因死亡率的独立预测指标（HR，1.66；95%CI，1.35 - 2.05；P <0.0001）。根据ROC确定区分存活组和死亡组的最佳截断值为0.97。LAR的AUC值为0.755（95%CI：0.721，0.789），高于单独的动脉血乳酸（AUC = 0.725）和血清白蛋白（AUC = 0.680）。即使与终末期肝病模型（MELD）（AUC = 0.677）相比也不逊色。
在我们的回顾性研究中，LAR对肝衰竭患者的全因死亡率显示出良好的预测价值。
