Association between the lactate-to-albumin ratio and 28-day all-cause mortality in critically ill patients with CKD: A retrospective analysis of the MIMIC-IV database

Abstract Purpose The lactate-to-albumin ratio (LAR) has been shown to be associated with adverse outcomes in various diseases. However, there has been no research investigating the impact of LAR on the prognosis of critically ill patients with chronic kidney disease (CKD). This study aimed to elucidate the ability of the LAR to predict 28-day all-cause mortality in critically ill patients with CKD. Methods We conducted a retrospective analysis of 4,271 critically ill patients with CKD using the MIMIC-IV database. The exposure factor was the LAR, and the outcome was the 28-day mortality rate. Hazard ratios (HRs) along with their corresponding 95% confidence intervals (95% CIs) were computed using multivariate Cox regression. Results Multivariable Cox regression analysis revealed that compared with that in the tertile 1 group, the HR for 28-day mortality in the tertile 2 group was 1.55 (95% CI: 1.26–1.92, P < 0.001), and the HR was 1.91 (95% CI: 1.54–2.36, P < 0.001). K-M analysis demonstrated that patients in the higher LAR group had higher 28-day, 90-day, and one-year mortality rates (P < 0.001). Conclusions Our study revealed that the LAR can independently predict the 28-day mortality rate in critically ill patients with CKD and can enhance the predictive value of various disease scores.