Wang Congying, Sun Xin, Chen Kun, Shi Yaqing, Wang Lili, Chen Shuxia, Li Dehua, Gu Jian
Hebei General Hospital, Shijiazhuang, Hebei, China.
Hebei North University, Zhangjiakou, Hebei, China.
Int J Cardiol Heart Vasc. 2025 Jul 1;59:101734. doi: 10.1016/j.ijcha.2025.101734. eCollection 2025 Aug.
The lactate-to-albumin ratio (LAR) is a novel biomarker associated with poor prognosis in critical illnesses. However, its relationship with cardiac surgery associated acute kidney injury (AKI) and prognosis remains unclear. This study aimed to investigate this relationship using data from the MIMIC database.
A retrospective cohort study was conducted on 11,624 adult cardiac surgery patients admitted to the ICU. Logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis were used to assess the predictive value of LAR for AKI occurrence and adverse outcomes.
Of the 11,624 patients, 5,965 developed AKI. While LAR concentrations were higher in AKI patients, this association did not persist after multivariate adjustment for potential confounder. Logistic regression showed that LAR was independently associated with in-hospital and ICU mortality, even after adjusting for potential confounders. RCS analysis revealed a non-linear relationship between elevated LAR and increased mortality risk in AKI patients. Correlation analyses demonstrated that LAR was associated with longer hospital and ICU stays and higher SOFA scores. Subgroup analyses consistently showed that elevated LAR was associated with increased mortality risk in older adults, females, and patients with or without hypertension, chronic kidney disease, diabetes, or chronic heart failure.
Among patients with acute kidney injury related to cardiac surgery, especially in those undergoing valve surgery, elevated LAR levels are associated with an increased risk of death, but not with the occurrence of acute kidney injury. Further validation is needed to confirm its predictive role.
乳酸与白蛋白比值（LAR）是一种与危重病预后不良相关的新型生物标志物。然而，其与心脏手术相关急性肾损伤（AKI）及预后的关系仍不明确。本研究旨在利用多中心重症医学信息数据库（MIMIC）的数据调查这种关系。
对入住重症监护病房（ICU）的11624例成年心脏手术患者进行回顾性队列研究。采用逻辑回归、限制性立方样条（RCS）分析和亚组分析来评估LAR对AKI发生及不良结局的预测价值。
11624例患者中，5965例发生AKI。虽然AKI患者的LAR浓度较高，但在对潜在混杂因素进行多变量调整后，这种关联不再存在。逻辑回归显示，即使在调整潜在混杂因素后，LAR仍与住院和ICU死亡率独立相关。RCS分析显示，AKI患者中LAR升高与死亡风险增加之间存在非线性关系。相关性分析表明，LAR与住院和ICU住院时间延长以及较高的序贯器官衰竭评估（SOFA）评分相关。亚组分析一致显示，LAR升高与老年人、女性以及患有或未患有高血压、慢性肾脏病、糖尿病或慢性心力衰竭的患者死亡风险增加相关。
在与心脏手术相关的急性肾损伤患者中，尤其是在接受瓣膜手术的患者中，LAR水平升高与死亡风险增加相关，但与急性肾损伤的发生无关。需要进一步验证以确认其预测作用。
