Association between lactate-to-albumin ratio and clinical outcomes in perioperative patients with chronic kidney disease: a retrospective cohort study based on INSPIRE database.

BACKGROUND

The clinical significance of the lactate-to-albumin ratio (LAR) in surgical patients with chronic kidney disease (CKD) remains underexplored. This research evaluated correlation between LAR and clinical prognosis in perioperative CKD patients.

METHODS

Using data from the INSPIRE database (2011-2020), we retrospectively analyzed 1906 surgical CKD patients categorized by admission LAR tertiles. Multivariable Cox/logistic/linear regression and restricted cubic spline (RCS) models assessed outcomes, adjusting for demographics, comorbidities, and perioperative factors.

RESULTS

The cohort (mean age 60.6 ± 14.7 years; 66.5% male) had a 6.7% in-hospital mortality rate. Elevated LAR was independently associated with in-hospital mortality (adjusted HR = 1.79, 95% CI 1.4-2.28, P < 0.001), with the highest tertile (T3) showing a 2.33-fold higher risk compared to T1 (P = 0.004). Secondary outcomes demonstrated similar trends: higher LAR correlated with increased 30-day mortality (adjusted HR = 2.02, 95% CI 1.49-2.73), ICU admission (adjusted OR = 2.35, 95% CI 1.57-3.53), CRRT use (adjusted OR = 3.01, 95% CI 2.06-4.39) and longer length of hospital stay (adjusted β = 5.28 days, 95% CI 0.64-9.93). Restricted cubic splines demonstrated a monotonically increasing risk of mortality and other adverse outcomes with rising LAR levels (all P for nonlinearity > 0.05).

CONCLUSION

Elevated LAR was associated with increased risk of in-hospital and 30-day mortality, ICU admission, CRRT use and longer length of hospital stay in surgical CKD patients. This ratio offers a practical biomarker for perioperative risk stratification in this clinical population.