ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. General Cardiovascular Medicine
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1636375
This article is part of the Research TopicSustainable Development Goal 3 (SDG#3) Initiatives, Milestones, Roadblocks, and Proposed Solutions in the Field of Cardiovascular MedicineView all articles
Association of lactate to albumin ratio with short-term and long-term mortality in critically ill patients with heart failure complicated by sepsis: a retrospective study using the MIMIC-IV database
Provisionally accepted
- 1Fujian Medical University, Fuzhou, China
- 2Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China
- 3Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Elevated lactate to albumin ratio (LAR) has been associated with poor prognosis in critical illnesses. However, evidence regarding LAR in patients with heart failure (HF) complicated by sepsis remains limited. This study aimed to explore the relationship between LAR and both short-term and long-term mortality in this population. Method: Patient data were extracted from the Medical Information Mart for Intensive Care (MIMIC-IV) database and stratified into quartiles based on LAR. The primary endpoints were 28-day and 365-day all-cause mortality. Kaplan-Meier survival analysis was performed to compare outcomes across the four groups. Association between LAR and mortality was assessed using restricted cubic splines (RCS) and Cox regression analysis. Additionally, subgroup and sensitivity analyses were conducted. Result: Among 4,242 participants (mean age 72.04 ± 13.50 years; 57.33% male), Kaplan-Meier analysis showed that higher LAR levels were associated with increased 28-day and 365-day all-cause mortality (log-rank P < 0.001). Cox regression analysis confirmed that elevated LAR was independently associated with higher 28-day and 365-day all-cause mortality (HR: 1.101, 95% CI 1.005-1.205; HR: 1.125, 95% CI 1.039-1.218). The highest LAR quartile (>0.97) remained significantly associated with both 28-day and 365-day mortality (Q4 vs. Q1: HR: 1.313, 95% CI 1.063-1.622; HR: 1.310, 95% CI 1.092-1.571). RCS analysis indicated a linear positive correlation between LAR and mortality (P for nonlinear > 0.05). Subgroup analysis revealed a significant interaction with hypertension (P for interaction = 0.033 for 28-day; P for interaction = 0.015 for 365-day). Sensitivity analyses confirmed the robustness of these findings. Conclusion: In critically ill patients with HF complicated by sepsis, LAR is a reliable and independent predictor of mortality. Patients in the highest LAR quartile (>0.97) have a significantly increased risk of death, providing a clinically useful reference for rapid identification of high-risk individuals. The significant interaction observed in hypertensive subgroups highlights the need for heightened clinical attention. Overall, LAR may serve as a practical biomarker for risk stratification and prognostic evaluation in this vulnerable population.
Keywords: Heart Failure, Sepsis, MIMIC-IV, lactate to albumin ratio, Mortality
Received: 27 May 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Wu, Wang and Wen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ling Wang, Fujian Medical University, Fuzhou, China
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.