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Objectives <p>Our study endeavors to elucidate the link of the lactic dehydrogenase-to-albumin ratio (LDAR) to all-cause mortality (ACM) among the critically ill obstructive sleep apnea (OSA) population.</p> Methods <p>A retrospective observational cohort study was performed leveraging the MIMIC-IV 3.1 data. This study encompassed adult OSA patients first entering the intensive care unit (ICU). Patients were stratified into quartiles by LDAR. The primary outcomes were ACM at 30, 90, 180 days, and one year after ICU entry. ACM across LDAR quartiles was compared via the Kaplan-Meier (KM) survival analysis. The relation of LDAR to ACM was examined utilizing multivariable Cox proportional hazards regression and restricted cubic spline (RCS) models. The consistency and robustness of our findings were rated through subgroup, interaction, and sensitivity analyses.</p> Results <p>One thousand one hundred eighteen critically ill OSA patients were encompassed. 749 (66.99%) were male, with a median age of 66. The 30-day, 90-day, 180-day, and one-year ACM rates were 14.58%, 19.59%, 22.00%, and 26.74%. KM curves demonstrated significantly higher mortality rates across increasing LDAR quartiles (log-rank <i>P</i> &lt; 0.001). After possible confounders were adjusted, LDAR was independently related to elevated 90-day ACM risk (HR, 1.318; 95%CI, 1.142–1.520) as a continuous variable. In contrast to the lowest LDAR quartile, the highest quartile displayed a 139.8% greater likelihood of 90-day ACM (HR, 2.398; 95%CI, 1.512–3.803; <i>P</i><sub>trend</sub> &lt; 0.001). Similar relations were noted for 30-day, 180-day, and one-year ACM. RCS analysis revealed a positive linear relation of LDAR to death at all time points (<i>P</i><sub>nonlinear</sub> &gt; 0.05). Subgroup and interaction analyses revealed insignificant effect modification, confirming the robustness of the association across various clinical strata.</p> Conclusion <p>Among the critically ill OSA population, elevated LDAR is independently and linearly related to elevated ACM risk in short-term and long-term mortality. The foregoing findings suggest LDAR as a valuable prognostic biomarker for risk classification and clinical management among this high-risk population.</p>

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Association between lactic dehydrogenase-to-albumin ratio and all-cause mortality in critical obstructive sleep apnea patients: a retrospective cohort study from the MIMIC-IV database

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Enhui Zhou,
  • Fan Song,
  • Chenyang Li,
  • Jingyu Zhang,
  • Tianjiao Zhou,
  • Weijun Huang,
  • Hongliang Yi

摘要

Objectives

Our study endeavors to elucidate the link of the lactic dehydrogenase-to-albumin ratio (LDAR) to all-cause mortality (ACM) among the critically ill obstructive sleep apnea (OSA) population.

Methods

A retrospective observational cohort study was performed leveraging the MIMIC-IV 3.1 data. This study encompassed adult OSA patients first entering the intensive care unit (ICU). Patients were stratified into quartiles by LDAR. The primary outcomes were ACM at 30, 90, 180 days, and one year after ICU entry. ACM across LDAR quartiles was compared via the Kaplan-Meier (KM) survival analysis. The relation of LDAR to ACM was examined utilizing multivariable Cox proportional hazards regression and restricted cubic spline (RCS) models. The consistency and robustness of our findings were rated through subgroup, interaction, and sensitivity analyses.

Results

One thousand one hundred eighteen critically ill OSA patients were encompassed. 749 (66.99%) were male, with a median age of 66. The 30-day, 90-day, 180-day, and one-year ACM rates were 14.58%, 19.59%, 22.00%, and 26.74%. KM curves demonstrated significantly higher mortality rates across increasing LDAR quartiles (log-rank P < 0.001). After possible confounders were adjusted, LDAR was independently related to elevated 90-day ACM risk (HR, 1.318; 95%CI, 1.142–1.520) as a continuous variable. In contrast to the lowest LDAR quartile, the highest quartile displayed a 139.8% greater likelihood of 90-day ACM (HR, 2.398; 95%CI, 1.512–3.803; Ptrend < 0.001). Similar relations were noted for 30-day, 180-day, and one-year ACM. RCS analysis revealed a positive linear relation of LDAR to death at all time points (Pnonlinear > 0.05). Subgroup and interaction analyses revealed insignificant effect modification, confirming the robustness of the association across various clinical strata.

Conclusion

Among the critically ill OSA population, elevated LDAR is independently and linearly related to elevated ACM risk in short-term and long-term mortality. The foregoing findings suggest LDAR as a valuable prognostic biomarker for risk classification and clinical management among this high-risk population.