He Susu, Wang Yongkang, Wei Shiyu, Yang Shifeng
Department of Nephrology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, China.
Front Med (Lausanne). 2025 Jun 5;12:1546112. doi: 10.3389/fmed.2025.1546112. eCollection 2025.
The lactate/albumin ratio (LAR) was related to adverse outcomes in heart failure, myocardial infarction, and acute pancreatitis. However, it remains unevaluated whether LAR has prognosis significance in sepsis-associated acute kidney injury (SA-AKI) patients. Therefore, this research was performed to clarify the potential predictive utility of LAR for 28-day mortality in SA-AKI patients.
Participants diagnosed with SA-AKI were selected from the Medical Information Mart for Intensive Care (MIMIC-IV) database and then placed into four groups in accordance with LAR quartiles. The endpoint was all-cause mortality within 28 days. The Kaplan-Meier curves were conducted to estimate the cumulative survival rates in the four groups. The correlation between LAR and the endpoint was elucidated by constructing Cox proportional hazards analysis, restricted cubic splines (RCS), and subgroup analysis.
Of the 3,895 patients with SA-AKI, 58.59% were men. The mortality rate from all causes within 28 days was 28.55%. The Kaplan-Meier curves showed that participants having elevated LAR exhibited significantly decreased survival rates. Cox proportional hazards models showed that higher LAR was related to higher 28-day death rate in SA-AKI patients (HR: 1.224, 95% CI: 1.160-1.291, < 0.001). In addition, RCS analyses revealed that LAR was non-linearly correlated with the risk of 28-day death.
LAR was independently related to an elevated risk of mortality within 28 days in SA-AKI patients. More prospective research studies are necessitated for further confirmation of these findings.
乳酸/白蛋白比值（LAR）与心力衰竭、心肌梗死和急性胰腺炎的不良预后相关。然而，LAR在脓毒症相关性急性肾损伤（SA-AKI）患者中是否具有预后意义仍未得到评估。因此，本研究旨在阐明LAR对SA-AKI患者28天死亡率的潜在预测效用。
从重症监护医学信息数据库（MIMIC-IV）中选取诊断为SA-AKI的参与者，然后根据LAR四分位数将其分为四组。终点为28天内的全因死亡率。采用Kaplan-Meier曲线估计四组的累积生存率。通过构建Cox比例风险分析、限制性立方样条（RCS）和亚组分析来阐明LAR与终点之间的相关性。
在3895例SA-AKI患者中，58.59%为男性。28天内的全因死亡率为28.55%。Kaplan-Meier曲线显示，LAR升高的参与者生存率显著降低。Cox比例风险模型显示，较高的LAR与SA-AKI患者较高的28天死亡率相关（HR：1.224，95%CI：1.160-1.291，<0.001）。此外，RCS分析显示，LAR与28天死亡风险呈非线性相关。
LAR与SA-AKI患者28天内死亡率升高独立相关。需要更多的前瞻性研究来进一步证实这些发现。
