Association between lactate-to-albumin ratio and mortality in obese patients with atrial fibrillation

Q: What are the key findings of this study?

An elevated baseline lactate-to-albumin ratio is independently associated with an increased 28-day mortality risk in obese ICU patients with atrial fibrillation.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Atrial fibrillation in obese critically ill patients (n=578). Intervention: Elevated lactate-to-albumin ratio (LAR) vs. Lower lactate-to-albumin ratio. Primary outcome: 28-day mortality (HR 1.20, 95% CI 1.01-1.43, p=0.039).

Q: What does this research mean for the field?

An elevated lactate-to-albumin ratio is independently associated with increased 28-day mortality in critically ill obese patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Rui Wu; Xinlian Zhong

doi:10.1186/s12872-026-06710-y

October 14, 2026BMC Cardiovascular DisordersOpen Access

Association between lactate-to-albumin ratio and mortality in obese patients with atrial fibrillation

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Key result

Elevated lactate-to-albumin ratio linked to ~20% higher 28-day mortality per unit in obese ICU AF patients.

HR 1.20
95% CI 1.01-1.43
P=0.039
n=578

Why the study?

The prognostic significance of the lactate-to-albumin ratio (LAR) for 28-day mortality in obese ICU patients with atrial fibrillation was unclear.

Does an elevated lactate-to-albumin ratio increase 28-day mortality in obese adult ICU patients with atrial fibrillation?

Key Points

To evaluate the association between the baseline lactate-to-albumin ratio and 28-day all-cause mortality in critically ill obese patients diagnosed with atrial fibrillation.
Retrospective cohort study conducted via the MIMIC-IV v3.1 database including N=578 adult ICU patients with atrial fibrillation and obesity (BMI ≥ 30 kg/m²).
Assessed the primary endpoint of 28-day mortality using LASSO regression for covariate selection, multivariate Cox proportional hazards models, restricted cubic spline modeling, and receiver operating characteristic analysis.
The overall 28-day mortality rate was 21.5%, with nonsurvivors demonstrating significantly higher median lactate-to-albumin ratios than survivors (0.74 vs. 0.54, p < 0.001).
Multivariable Cox regression revealed that elevated baseline ratio independently increased 28-day mortality risk (HR: 1.20, 95% CI: 1.01–1.43, p < 0.05), following a continuous linear risk pattern (P overall < 0.001, P non-linear = 0.212).
An optimal ratio cutoff of 1.185 predicted mortality with 33.9% sensitivity, 89.9% specificity, an AUC of 0.653, and significantly lower cumulative survival (HR: 3.80, 95% CI: 2.61–5.51, p < 0.001).

Study Design

Type

Cohort (n=578)

Structured PICO

Does an elevated lactate-to-albumin ratio increase 28-day mortality in obese adult ICU patients with atrial fibrillation?

P

Population

578 obese adult patients with atrial fibrillation admitted to the intensive care unit, followed for 28-day all-cause mortality.

E

Exposure

Elevated lactate-to-albumin ratio (LAR) evaluated continuously or dichotomized at optimal cutoff of 1.185

C

Comparator

Lower lactate-to-albumin ratio (LAR) or LAR <1.185

O

Outcome

All-cause 28-day mortality (death from any cause within 28 days of ICU admission)hard clinical

Main Result

Hazard Ratio: 1.2 (95% CI 1.01–1.43)

p-value: p=0.039

The lactate-to-albumin ratio is independently associated with 28-day mortality in obese ICU patients with atrial fibrillation and can serve as a modest adjunctive biomarker for risk stratification.

Limitations

Retrospective observational design limits the ability to establish causality.
Short 28-day observation window restricts insights into long-term cardiovascular prognosis.
Potential confounding by indication and survivor bias, particularly regarding therapeutic interventions like beta-blockers and anticoagulants.
Subgroup analyses are exploratory, subject to multiplicity, and have reduced statistical power within smaller clinical strata.
Modest discriminative performance (AUC = 0.653)
Secondary evaluations are inherently subject to potential multiplicity (inflation of type-I error from multiple comparisons)
Reduced statistical power within smaller clinical strata
Therapeutic subgroups reflect baseline illness severity and prescribing selection bias rather than direct drug toxicity or protective efficacy

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Implication

Supports adjunctive mortality risk stratification in obese AF ICU patients; hypothesis-generating and requires prospective validation.

Abstract

Background The lactate-to-albumin ratio (LAR) is a composite biomarker reflecting both metabolic stress and nutritional status. This study aimed to explore its association with 28-day mortality in obese patients with atrial fibrillation (AF). Methods We conducted a retrospective cohort study via the MIMIC-IV v3.1 database. The primary outcome was 28-day mortality. Cox proportional hazards models, LASSO regression, restricted cubic spline (RCS) modeling, and receiver operating characteristic (ROC) curve analyses were used to assess the prognostic significance of the LAR. Results Among 578 patients, the 28-day mortality rate was 21.5%. Nonsurvivors presented significantly greater LAR values (0.74 vs. 0.54, p < 0.001). In multivariate Cox regression adjusted for demographic, clinical, and therapeutic variables, an elevated LAR remained independently associated with 28-day mortality (HR: 1.20, 95% CI: 1.01–1.43, p < 0.05). RCS regression was utilized to flexibly model the continuous association between baseline LAR and 28-day mortality. Mortality risk increased continuously across higher LAR values, with no statistically significant departure from linearity detected (P overall < 0.001, P non-linear = 0.212). Failure to reject the null hypothesis of linearity indicates that a linear Cox model provides a reasonable representation of the observed continuous risk continuum, rather than proving a strictly linear biological mechanism. The optimal LAR cutoff (1.185) yielded a specificity of 89.9% and a sensitivity of 33.9%. Kaplan–Meier analysis revealed significantly lower survival in patients with high LAR (HR: 3.80, 95% CI: 2.61–5.51, p < 0.001). Subgroup analyses demonstrated consistent prognostic performance across demographic and clinical strata. Conclusions The LAR is independently associated with 28-day mortality in obese ICU patients with AF. Given its modest discriminative performance (AUC = 0.653), the LAR should be viewed as a modest adjunctive biomarker for risk stratification rather than a standalone clinical decision-making tool.

Discussion

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Cite This Study

Wu et al. (2026) conducted a cohort in Atrial fibrillation in obese critically ill patients (n=578). Elevated lactate-to-albumin ratio (LAR) vs. Lower lactate-to-albumin ratio was evaluated on 28-day mortality (HR 1.20, 95% CI 1.01-1.43, p=0.039). An elevated baseline lactate-to-albumin ratio is independently associated with an increased 28-day mortality risk in obese ICU patients with atrial fibrillation.

synapsesocial.com/papers/6ad0ba5d3983294737c0c5b9 https://doi.org/10.1186/s12872-026-06710-y

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Association between lactate-to-albumin ratio and mortality in obese patients with atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Association between lactate-to-albumin ratio and mortality in obese patients with atrial fibrillation

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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