March 29, 2025BMC Cardiovascular DisordersOpen Access

The impact of the lactate-to-albumin ratio on long-term mortality risk in patients with severe heart failure and type 2 diabetes

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Why the study?

Heart failure combined with diabetes is highly prevalent and associated with worse outcomes, making early prognostic prediction crucial.

Does an elevated lactate-to-albumin ratio predict increased long-term all-cause mortality in critically ill patients with severe heart failure and type 2 diabetes?

Structured PICO

Does an elevated lactate-to-albumin ratio predict increased long-term all-cause mortality in critically ill patients with severe heart failure and type 2 diabetes?

Population

3,774 critically ill patients with severe heart failure (HF) and type 2 diabetes (T2D) admitted to the intensive care unit (ICU) for the first time, median age 69, 56.6% male, 66.5% Caucasian. Data sourced from the MIMIC-IV database (USA).

Intervention

High lactate-to-albumin ratio (LAR) ≥ 0.44 at ICU admission

Comparator

Low lactate-to-albumin ratio (LAR) < 0.44 at ICU admission

Outcome

Long-term all-cause mortality at 180 dayshard clinical

An elevated lactate-to-albumin ratio (≥0.44) at ICU admission is an independent predictor of increased short- and long-term all-cause mortality in critically ill patients with heart failure and type 2 diabetes.

Implication

May support LAR for risk stratification in HF with diabetes; leaves open prospective validation before clinical use.

Abstract

BACKGROUND: Heart failure (HF) combined with diabetes is highly prevalent and is associated with more severe left ventricular dysfunction and a higher mortality rate. Early prediction of prognosis in such patients is crucial. This study aims to investigate the relationship between the lactate-to-albumin ratio (LAR) and outcomes in critically ill patients diagnosed with HF and diabetes. METHODS: Data on critically ill HF patients with diabetes were retrospectively collected from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Restricted cubic spline (RCS) analysis identified a threshold value of 0.44, dividing patients into low-LAR (< 0.44) and high-LAR (≥ 0.44) groups. Least Absolute Shrinkage and Selection Operator (LASSO) regression with tenfold cross-validation identified variables associated with mortality. RCS, Kaplan-Meier curves, and Cox regression analyses were employed to evaluate the association between LAR and mortality. Subgroup analyses were conducted to validate the robustness of the findings. RESULTS: A total of 3,774 patients were included, with a determined LAR cutoff value of 0.44. RCS analysis revealed a positive correlation between LAR and all-cause mortality at 90 days, 180 days, and 1 year. Cox regression analysis showed that both low-LAR and high-LAR groups were independent risk factors for all-cause mortality at 90 days, 180 days, and 1 year in HF patients with diabetes (P < 0.05). Kaplan-Meier survival curves demonstrated that the cumulative survival rates at 90 days, 180 days, and 1 year were lower in the low-LAR group compared to the high-LAR group. Subgroup analyses confirmed the stability of the association between LAR and all-cause mortality at all time points. CONCLUSION: In summary, LAR is a reliable and independent predictor of increased mortality in critically ill HF patients with diabetes. However, additional comprehensive prospective studies are needed to validate these findings.