Clinics (Sao Paulo, Brazil) · 2026
Lactate dehydrogenase-to-Albumin Ratio (LAR) predicts mortality in critically ill patients with hypertensive heart failure: A MIMIC-IV database analysis.
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Tu Guang, Cai Zhonglan, Jiang Hongke, Zhang Liling, Hu Huanhuan, Luo Haijian
Аннотация
BACKGROUND: Hypertensive heart disease with heart failure is a severe cardiovascular condition with high mortality rates. The relationship between the Lactate Dehydrogenase to Albumin Ratio (LAR) and mortality in these patients remains unclear.
METHODS: The authors analyzed 3019 patients with hypertensive heart failure using data from the MIMIC-IV database. Cox regression models were used to assess the association between LAR and mortality, with adjustments for various covariates. Restricted cubic spline analysis was employed to evaluate the threshold effect of LAR on mortality. Kaplan-Meier survival curves and subgroup analyses further explored the impact of LAR.
RESULTS: LAR was significantly associated with increased mortality across all time points: hospital mortality (HR = 4.86, 95% CI 4.12 to 5.73; p < 0.001), 30-day mortality (HR = 4.16, 95% CI 3.56 to 4.87; p < 0.001), 90-day mortality (HR = 3.56, 95% CI 3.08 to 4.12; p < 0.001), and 365-day mortality (HR = 2.91, 95% CI 2.54 to 3.33; p < 0.001). These associations remained significant after multivariable adjustments. The Cox regression model with restricted cubic spline analysis revealed a threshold effect of LAR on mortality, with turning points at 1.662 for hospital mortality, 2.393 for 30-day mortality, 2.407 for 90-day mortality, and 2.406 for 365-day mortality (all p < 0.001 for non-linear tests). Kaplan-Meier survival curves showed significant differences in survival across LAR quartiles for all mortality outcomes (all p < 0.001).
CONCLUSION: The LAR is significantly associated with mortality in critically ill patients, with a clear threshold effect. LAR may serve as a potential prognostic marker for identifying high-risk patients.
METHODS: The authors analyzed 3019 patients with hypertensive heart failure using data from the MIMIC-IV database. Cox regression models were used to assess the association between LAR and mortality, with adjustments for various covariates. Restricted cubic spline analysis was employed to evaluate the threshold effect of LAR on mortality. Kaplan-Meier survival curves and subgroup analyses further explored the impact of LAR.
RESULTS: LAR was significantly associated with increased mortality across all time points: hospital mortality (HR = 4.86, 95% CI 4.12 to 5.73; p < 0.001), 30-day mortality (HR = 4.16, 95% CI 3.56 to 4.87; p < 0.001), 90-day mortality (HR = 3.56, 95% CI 3.08 to 4.12; p < 0.001), and 365-day mortality (HR = 2.91, 95% CI 2.54 to 3.33; p < 0.001). These associations remained significant after multivariable adjustments. The Cox regression model with restricted cubic spline analysis revealed a threshold effect of LAR on mortality, with turning points at 1.662 for hospital mortality, 2.393 for 30-day mortality, 2.407 for 90-day mortality, and 2.406 for 365-day mortality (all p < 0.001 for non-linear tests). Kaplan-Meier survival curves showed significant differences in survival across LAR quartiles for all mortality outcomes (all p < 0.001).
CONCLUSION: The LAR is significantly associated with mortality in critically ill patients, with a clear threshold effect. LAR may serve as a potential prognostic marker for identifying high-risk patients.