Association between lactate-to-albumin ratio and the short-time mortality of patients with ischemic stroke in intensive care unit

Patients with severe acute ischemic stroke (IS) often face poor outcomes and extended hospital stays. Early prognosis prediction aids in creating personalized treatment plans. The lactate-to-albumin ratio (LAR) is linked to poor outcomes in various illnesses, but its connection to all-cause mortality in ischemic stroke patients is not well understood. This study aims to investigate the prognostic value of LAR in these IS patients in intensive care unit. This retrospective cohort study utilized MIMIC-IV (v2.2) data to identify intensive care unit (ICU) patients with acute IS. Lactate and albumin levels were measured upon admission, and LAR was calculated. The primary focus of our study was on 28-day all-cause mortality. Cox proportional hazards analysis and receiver operating characteristic curves assessed the link between LAR and mortality, while Kaplan–Meier analysis compared mortality rates between high and low LAR groups. Restricted cubic splines examined the nonlinear relationship between LAR and mortality. The study analyzed 703 IS patients in the ICU, median age of 69.9 years: 387 men (55%) and 316 women (45%), finding a 28-day mortality rate of 30.6%. A significant correlation existed between LAR and mortality (adjusted HR: 1.24; 95% CI: 1.06–1.44; p = 0.006). The AUC of final multivariate model was 0.831 (95% CI: 0.800–0.862). Kaplan-Meier curves indicated higher mortality risk in the high-LAR group (log rank p < 0.001). LAR showed a nonlinear relationship with mortality (p for nonlinear < 0.001). The LAR was significantly associated with the 28-day mortality in IS patients in the ICU, suggesting its potential utility as a prognostic biomarker.