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Background <p>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.</p> Methods <p>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.</p> Result <p>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 (<i>P</i> &lt; 0.001), with K-M analysis revealing significantly worse survival in higher LAR groups (<i>P</i> &lt; 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).</p> Conclusion <p>The LAR independently predicts short- and long-term mortality in critically ill gastrointestinal bleeding patients.</p>

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

  • 期刊论文

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  • 发表日期：

    2025年9月26日

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

摘要

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.