Dong Yanyan, Shi Xiaoyu, Wang Chenghao, Hu Yinqin, Li Junxiong, Luo Hong, Zhu Maoping, Hu Fan, Chu Quangen
School of Traditional Chinese Medicine, Anhui University of Chinese Medicine, Anhui Hefei, China.
Key Laboratory of Xinan Medicine,Ministry of Education, Anhui University of Chinese Medicine, Anhui Hefei, China.
BMC Cardiovasc Disord. 2025 Mar 29;25(1):234. doi: 10.1186/s12872-025-04612-z.
Heart failure (HF) combined with diabetes is highly prevalent and is associated with more severe left ventricular dysfunction and a higher mortality rate. Early prediction of prognosis in such patients is crucial. This study aims to investigate the relationship between the lactate-to-albumin ratio (LAR) and outcomes in critically ill patients diagnosed with HF and diabetes.
Data on critically ill HF patients with diabetes were retrospectively collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Restricted cubic spline (RCS) analysis identified a threshold value of 0.44, dividing patients into low-LAR (< 0.44) and high-LAR (≥ 0.44) groups. Least Absolute Shrinkage and Selection Operator (LASSO) regression with tenfold cross-validation identified variables associated with mortality. RCS, Kaplan-Meier curves, and Cox regression analyses were employed to evaluate the association between LAR and mortality. Subgroup analyses were conducted to validate the robustness of the findings.
A total of 3,774 patients were included, with a determined LAR cutoff value of 0.44. RCS analysis revealed a positive correlation between LAR and all-cause mortality at 90 days, 180 days, and 1 year. Cox regression analysis showed that both low-LAR and high-LAR groups were independent risk factors for all-cause mortality at 90 days, 180 days, and 1 year in HF patients with diabetes (P < 0.05). Kaplan-Meier survival curves demonstrated that the cumulative survival rates at 90 days, 180 days, and 1 year were lower in the low-LAR group compared to the high-LAR group. Subgroup analyses confirmed the stability of the association between LAR and all-cause mortality at all time points.
In summary, LAR is a reliable and independent predictor of increased mortality in critically ill HF patients with diabetes. However, additional comprehensive prospective studies are needed to validate these findings.
心力衰竭（HF）合并糖尿病非常普遍，并且与更严重的左心室功能障碍和更高的死亡率相关。对此类患者预后的早期预测至关重要。本研究旨在探讨乳酸与白蛋白比值（LAR）与诊断为HF和糖尿病的危重病患者预后之间的关系。
从重症监护医学信息数据库IV（MIMIC-IV）中回顾性收集糖尿病合并重症HF患者的数据。受限立方样条（RCS）分析确定阈值为0.44，将患者分为低LAR（<0.44）和高LAR（≥0.44）组。采用十折交叉验证的最小绝对收缩和选择算子（LASSO）回归确定与死亡率相关的变量。采用RCS、Kaplan-Meier曲线和Cox回归分析评估LAR与死亡率之间的关联。进行亚组分析以验证研究结果的稳健性。
共纳入3774例患者，确定的LAR临界值为0.44。RCS分析显示，LAR与90天、180天和1年时的全因死亡率呈正相关。Cox回归分析表明，低LAR组和高LAR组都是糖尿病HF患者90天、180天和1年时全因死亡率的独立危险因素（P<0.05）。Kaplan-Meier生存曲线表明，低LAR组90天、180天和1年时的累积生存率低于高LAR组。亚组分析证实了LAR与各时间点全因死亡率之间关联的稳定性。
总之，LAR是糖尿病合并重症HF患者死亡率增加的可靠且独立的预测指标。然而，需要更多全面的前瞻性研究来验证这些发现。
