What question did this study set out to answer?

This research aims to determine the relationship between lactate-to-albumin ratio (LAR) and 28-day mortality in patients with ventilator-associated pneumonia (VAP).

January 22, 2026

Association Between Lactate-to-albumin Ratio and 28-day Mortality in Patients with Ventilator-associated Pneumonia

Key Points

This research aims to determine the relationship between lactate-to-albumin ratio (LAR) and 28-day mortality in patients with ventilator-associated pneumonia (VAP).
Utilized MIMIC-IV database for data collection.
Analyzed 591 patients with VAP categorized into tertiles of LAR.
Employed univariate and multivariate Cox regression analyses to assess mortality risk.
Used restricted cubic spline and Kaplan–Meier curves to evaluate correlations and survival rates.
22.0% of VAP patients died within 28 days.
Multivariable Cox regression indicated LAR significantly influences mortality risk (HR = 1.22).
Positive correlation between LAR and 28-day mortality confirmed through spline analysis.
High-LAR group showed significantly lower survival rates compared to low- and medium-LAR groups.

Abstract

Background: Ventilator-associated pneumonia (VAP) is a frequent complication for those receiving invasive mechanical ventilation in the ICU, exerts significant impacts on clinical outcomes. We aimed to explore the association between LAR and 28-day mortality in those suffering from VAP. Methods: This investigation utilized clinically granular data from MIMIC-IV database. Altogether, 591 patients with VAP were ultimately collected for analysis. Participants were categorized into three groups in accordance with tertiles of LAR. The key clinical endpoint was 28-day all-cause mortality. Univariate Cox Regression, Multivariate Cox Regression, RCS (Restricted cubic spline), Kaplan–Meier curve, and Subgroup analyses were used to examine the association between LAR and 28-day mortality among critical care patients with VAP. Results: Of the VAP patients, 22.0% succumbed within the 28-day observational window. According to the multivariable Cox regression analysis, LAR independently influenced the 28-day mortality risk in VAP patients (adjusted HR = 1.22, 95% CI: 1.06~1.39, P = 0.005). Restricted cubic spline analysis revealed a positive correlation between LAR and 28-day mortality. Subgroup analyses confirmed consistent associations across diverse patient characteristics. Kaplan-Meier curves demonstrated that patients in the high-LAR group had significantly lower survival probabilities compared to the low- and medium-LAR groups, suggesting that patients with VAP who have elevated LAR face a greater risk of mortality within 28 days. Conclusion: In summary, our study revealed a positive dose-response association between LAR and 28-day mortality in patients with VAP, suggesting that LAR is identified as an independent risk factor for unfavorable clinical outcomes in this population.

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