What question did this study set out to answer?

This analysis aims to evaluate the lactate dehydrogenase-to-albumin ratio (LAR) as a prognostic tool for mortality in glucocorticoid-treated pneumonia patients in the ICU.

May 9, 2026Frontiers in Medicine0 citationsOpen Access

Lactate dehydrogenase-to-albumin ratio predicts 30-day and 90-day mortality in glucocorticoid-treated ICU patients with pneumonia: a secondary analysis of a multicenter cohort

DHDandan HanAffiliated Hospital of Jining Medical University SSShengfa SunAffiliated Hospital of Jining Medical University 刘刘艾Affiliated Hospital of Jining Medical University

Key Points

This analysis aims to evaluate the lactate dehydrogenase-to-albumin ratio (LAR) as a prognostic tool for mortality in glucocorticoid-treated pneumonia patients in the ICU.
Secondary analysis of a multicenter cohort with 499 ICU patients.
Determined optimal LAR cutoff using the Youden index and assessed mortality associations via multivariable Cox regression.
Evaluated predictive value with net reclassification improvement and integrated discrimination improvement.
Optimal LAR cutoff was 13.39; high LAR (≥13.39) associated with 30-day mortality of 45.8% vs. 12.1%, and 90-day mortality of 51.4% vs. 14.3% (p<0.001).
High LAR remained an independent predictor for 30-day (HR 2.07, 95% CI 1.34–3.20) and 90-day mortality (HR 1.93, 95% CI 1.29–2.89).
LAR demonstrated good discrimination (AUC ≈ 0.74) and significant predictive value when added to PSI score (NRI 0.299, p=0.048).

Abstract

Background Glucocorticoid therapy in pneumonia patients confounds conventional inflammatory biomarkers, hindering accurate risk stratification. The lactate dehydrogenase-to-albumin ratio (LAR), a proposed steroid-resilient index reflecting cellular injury and nutritional reserve, may offer prognostic utility in this population. Methods This secondary analysis of a multicenter cohort included 499 ICU patients with pneumonia receiving glucocorticoids. The optimal LAR cutoff for 30-day mortality was determined via the Youden index. Associations with 30- and 90-day mortality were assessed using multivariable Cox regression and propensity score matching (PSM), with doubly robust estimation serving as the primary analysis in the matched cohort. Incremental predictive value was evaluated using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results The optimal LAR cutoff was 13.39. High LAR (≥13.39) was associated with significantly higher 30-day (45.8% vs. 12.1%) and 90-day (51.4% vs. 14.3%) mortality (both p 0.001). After full multivariable adjustment, high LAR remained an independent predictor for 30-day (HR 2.07, 95% CI 1.34–3.20) and 90-day (HR 1.93, 95% CI 1.29–2.89) mortality. In the PSM cohort, the doubly robust estimate yielded consistent findings (30-day HR 2.07, 95% CI 1.34–3.21; 90-day HR 1.93, 95% CI 1.29–2.90). Sensitivity analyses treating LAR as a continuous variable and as tertiles confirmed a dose–response relationship independent of any single threshold. LAR demonstrated good discrimination (AUC ≈ 0.74) and provided significant incremental prognostic value when added to the PSI score (NRI 0.299, p = 0.048). Conclusion LAR is a simple, readily available, and steroid-resilient biomarker that independently predicts short- and mid-term mortality in pneumonia patients receiving glucocorticoids. Incorporating LAR into clinical assessment may enhance early risk stratification and guide individualized management in this challenging population.

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