Xu Junhao, Wu Shaoxing, Li Haipeng, Chen Xinming, Zhou You, Xu Yinji
The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, Guangdong, China.
Clin Appl Thromb Hemost. 2025 Jan-Dec;31:10760296251366420. doi: 10.1177/10760296251366420. Epub 2025 Aug 6.
BackgroundThe lactate-to-albumin ratio (LAR) has prognostic value in various clinical conditions, but its association with mortality in pulmonary embolism (PE) remains unclear. This study aims to investigate the relationship between LAR and 28-day all-cause mortality in PE patients.MethodsThis retrospective observational study used MIMIC-IV database, with 28-day mortality as the primary endpoint. Adjusted Cox models were used to assessed the LAR-mortality association, with subgroup analyses for stability. Kaplan-Meier curves estimated mortality across LAR tertiles. Restricted cubic spline(RCS) analysis evaluated nonlinearity. Receiver operating characteristic curves(ROC) and reclassification metrics were used to compare the predictive performance of LAR with the Pulmonary Embolism Severity Index (PESI).ResultsAmong the 319 included patients, 72 (22.6%) died within 28 days of admission. Non-survivors had significantly higher LAR levels. In adjusted Cox models, elevated LAR was independently associated with increased 28-day mortality risk. Kaplan-Meier curves showed significant survival differences across LAR tertiles. RCS analysis revealed a dose-response relationship with an inflection point around LAR 0.67. The ROC curve's C-statistic, validated by the DeLong test, highlights the superior performance of the LAR model, while the positive Integrated Discrimination Improvement and Net Reclassification Improvement values demonstrate its additional prognostic value over the PESI model. Subgroup analysis confirmed consistent findings across different patient groups.ConclusionElevated LAR was positively correlated with 28-day all-cause mortality in PE patients, maintaining prognostic value across subgroups. LAR showed potential as a practical prognostic indicator for PE risk stratification, warranting prospective validation and exploration of its clinical utility in PE management.
乳酸与白蛋白比值（LAR）在多种临床情况下具有预后价值，但其与肺栓塞（PE）患者死亡率的关系仍不明确。本研究旨在探讨PE患者中LAR与28天全因死亡率之间的关系。
本回顾性观察性研究使用MIMIC-IV数据库，以28天死亡率作为主要终点。采用校正后的Cox模型评估LAR与死亡率的关联，并进行亚组分析以评估稳定性。Kaplan-Meier曲线估计了LAR三分位数的死亡率。采用限制立方样条（RCS）分析评估非线性关系。使用受试者工作特征曲线（ROC）和重新分类指标比较LAR与肺栓塞严重程度指数（PESI）的预测性能。
在纳入的319例患者中，72例（22.6%）在入院28天内死亡。非幸存者的LAR水平显著更高。在校正后的Cox模型中，LAR升高与28天死亡风险增加独立相关。Kaplan-Meier曲线显示LAR三分位数之间存在显著的生存差异。RCS分析显示存在剂量反应关系，拐点约为LAR 0.67。经DeLong检验验证的ROC曲线C统计量突出了LAR模型的优越性能，而阳性的综合判别改善和净重新分类改善值表明其比PESI模型具有额外的预后价值。亚组分析证实了不同患者组的一致结果。
LAR升高与PE患者28天全因死亡率呈正相关，在各亚组中均保持预后价值。LAR显示出作为PE风险分层实用预后指标的潜力，值得进行前瞻性验证并探索其在PE管理中的临床应用价值。
