乳酸与白蛋白比值作为胃肠道出血重症患者死亡率的独立预测指标：一项回顾性队列研究

Lactate-to-albumin ratio as an independent predictor of mortality in critically ill patients with gastrointestinal bleeding: a retrospective cohort study.

作者信息

Yang Xingyi, Ying Shasha, Yuan Xiangshu, Ying Jiaqian, Yang Ji, Lv Lihong

机构信息

Department of Gastroenterology Disease, XianJu People's Hospital, Zhejiang Southeast Campus of Zhejiang Provincial People's Hospital, Affiliated Xianju's Hospital, Hangzhou Medical College, 53 Beidong Road, Xianju County, Taizhou, Zhejiang, 317300, China.

Department of Nursing, Yunnan Technology and Business University, Kunming, China.

出版信息

BMC Gastroenterol. 2025 Sep 26;25(1):653. doi: 10.1186/s12876-025-04244-9.

DOI:10.1186/s12876-025-04244-9

PMID:41013310

Abstract

BACKGROUND

The lactate-to-albumin ratio (LAR) is an established prognostic marker in various critical illnesses; However, its association with gastrointestinal bleeding (GIB) in patients has not been thoroughly investigated. This study evaluates the prognostic role of LAR in critically ill patients with GIB.

METHODS

Data were extracted from the publicly available MIMIC-IV database (v3.1). We assessed the prognostic value of the LAR for both short- and long-term mortality using multivariable Cox proportional hazards regression. Survival differences were analyzed using Kaplan-Meier (K-M) curves with log-rank tests. Discrimination ability was evaluated using receiver operating characteristic (ROC) curve analysis, while nonlinear associations were examined using restricted cubic splines (RCS). Subgroup analyses were conducted to test for potential effect modification. Finally, a Boruta algorithm-based nomogram was developed to integrate key predictors.

RESULT

This retrospective cohort study enrolled 1,210 critically ill patients with gastrointestinal bleeding, demonstrating an ICU mortality rate of 21.7%. Using X-tile analysis, we stratified patients into tertiles (Q1-Q3) based on LAR and 28-day mortality. Multivariable Cox regression confirmed LAR as an independent predictor of mortality (P < 0.001), with K-M analysis revealing significantly worse survival in higher LAR groups (P < 0.001). ROC analysis showed moderate predictive accuracy, while integrating LAR with SOFA score enhanced performance compared to either parameter alone. Decision curve analysis (DCA) demonstrated clinical utility, and RCS regression indicated a linear dose-response relationship between LAR and mortality risk. Subgroup analyses revealed no significant effect modification. A Boruta-optimized nomogram incorporating LAR achieved robust predictive performance for 28-day (AUC 0.780, 95% CI 0.750-0.811), 90-day (0.777, 0.749-0.805), and 365-day mortality (0.773, 0.745-0.800).

CONCLUSION

The LAR independently predicts short- and long-term mortality in critically ill gastrointestinal bleeding patients.

摘要

背景

乳酸与白蛋白比值（LAR）是多种危重病中已确立的预后标志物；然而，其与患者胃肠道出血（GIB）的关联尚未得到充分研究。本研究评估LAR在GIB危重症患者中的预后作用。

方法

数据从公开可用的MIMIC-IV数据库（v3.1）中提取。我们使用多变量Cox比例风险回归评估LAR对短期和长期死亡率的预后价值。使用Kaplan-Meier（K-M）曲线和对数秩检验分析生存差异。使用受试者工作特征（ROC）曲线分析评估辨别能力，使用受限立方样条（RCS）检验非线性关联。进行亚组分析以测试潜在的效应修正。最后，开发了一种基于Boruta算法的列线图以整合关键预测因素。

结果

这项回顾性队列研究纳入了1210例GIB危重症患者，ICU死亡率为21.7%。使用X-tile分析，我们根据LAR和28天死亡率将患者分为三分位数（Q1-Q3）。多变量Cox回归确认LAR是死亡率的独立预测因素（P < 0.001），K-M分析显示较高LAR组的生存率明显更差（P < 0.001）。ROC分析显示出中等预测准确性，与单独的任何一个参数相比，将LAR与SOFA评分相结合可提高性能。决策曲线分析（DCA）证明了临床实用性，RCS回归表明LAR与死亡风险之间存在线性剂量反应关系。亚组分析未发现显著的效应修正。纳入LAR经Boruta优化的列线图对28天（AUC 0.780，95% CI 0.750-0.811）、90天（0.777，0.749-0.8）和365天死亡率（0.773，0.745-0.8）具有强大的预测性能。