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Background <p>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.</p> Methods <p>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 (&lt; 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.</p> Results <p>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&#xa0;days, 180&#xa0;days, and 1&#xa0;year. Cox regression analysis showed that both low-LAR and high-LAR groups were independent risk factors for all-cause mortality at 90&#xa0;days, 180&#xa0;days, and 1&#xa0;year in HF patients with diabetes (<i>P</i> &lt; 0.05). Kaplan–Meier survival curves demonstrated that the cumulative survival rates at 90&#xa0;days, 180&#xa0;days, and 1&#xa0;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.</p> Conclusion <p>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.</p>

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

  • 期刊论文

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  • 发表日期：

    2025年3月29日

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  • Yanyan Dong,
  • Xiaoyu Shi,
  • Chenghao Wang,
  • Yinqin Hu,
  • Junxiong Li,
  • Hong Luo,
  • Maoping Zhu,
  • Fan Hu,
  • Quangen Chu

摘要

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.