View in EDS

Association Between the Lactate‐to‐Albumin Ratio and ICU/In‐Hospital Mortality in Critically Ill Patients With Comorbid Type 2 Diabetes Mellitus : A Cohort Study Utilizing the MIMIC‐IV Database.

Saved in:
Bibliographic Details
Title: Association Between the Lactate‐to‐Albumin Ratio and ICU/In‐Hospital Mortality in Critically Ill Patients With Comorbid Type 2 Diabetes Mellitus : A Cohort Study Utilizing the MIMIC‐IV Database.
Authors: Cheng, Zhuo-Ting, Wang, Jia-Liang, Zhao, Yan-Bo, Zhao, Zheng-Ming, Li, Zhi-Jun, Liu, Yang, Cirocchi, Roberto
Source: Emergency Medicine International; 4/13/2026, Vol. 2026, p1-13, 13p
Subject Terms: TYPE 2 diabetes, BIOMARKERS, HOSPITAL mortality, PROGNOSIS, COHORT analysis, CRITICAL care medicine, CRITICALLY ill, MEDICAL databases
Abstract: Background: Type 2 diabetes mellitus (T2DM) accounts for over 90% of diabetes cases worldwide, and its rising prevalence poses a substantial public health challenge. The lactate‐to‐albumin ratio (LAR) is a novel biomarker that reflects both metabolic stress and nutritional‐inflammatory status, and it has demonstrated independent prognostic value in various critical illnesses. However, its association with mortality in critically ill patients with T2DM remains unclear. This study aims to evaluate the predictive value of LAR for prognosis in this specific patient population through a retrospective analysis. Methods: This retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) v3.0 database, which includes complete medical records of patients admitted to the intensive care unit (ICU) of a U.S. medical center between 2008 and 2022. Subjects were categorized into three groups based on LAR tertiles. The study assessed ICU mortality and in‐hospital mortality as primary outcomes; 30‐day, 90‐day, and 365‐day mortality after ICU admission served as secondary outcomes. Machine learning identified key variables related to LAR and outcomes. The association between LAR and primary outcomes was analyzed using multivariate logistic regression and restricted cubic spline (RCS) regression. Cumulative mortality was analyzed using Kaplan–Meier curves. Threshold effects were evaluated using generalized additive models to enhance clinical applicability. Sensitivity and subgroup analyses were used to validate the robustness of the results and the interactions within subgroups. Result: The study included 5463 critically ill T2DM patients. Using Boruta and SHapley Additive exPlanations (SHAP) algorithms, 14 key variables were identified. RCS analysis revealed a nonlinear relationship between LAR and in‐hospital mortality (p for nonlinearity = 0.001). Threshold effect analysis identified a critical LAR threshold of 2.10. Kaplan–Meier survival curves showed that higher LAR values were correlated with increased mortality (p < 0.001). Subgroup analyses revealed significant interactions in gender subgroups for ICU mortality (p for interaction = 0.043) and in hyperlipidemia (HLD) subgroups for in‐hospital mortality (p for interaction = 0.049). Sensitivity analyses confirmed robust associations between LAR and ICU mortality (OR 1.32, 95% CI: 1.20–1.45, p < 0.001) and in‐hospital mortality (OR 1.37, 95% CI: 1.26–1.50, p < 0.001). Conclusion: This study identified a significant correlation between elevated LAR and adverse ICU outcomes in critically ill patients with T2DM. [ABSTRACT FROM AUTHOR]
Copyright of Emergency Medicine International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Biomedical Index
Description
Abstract:Background: Type 2 diabetes mellitus (T2DM) accounts for over 90% of diabetes cases worldwide, and its rising prevalence poses a substantial public health challenge. The lactate‐to‐albumin ratio (LAR) is a novel biomarker that reflects both metabolic stress and nutritional‐inflammatory status, and it has demonstrated independent prognostic value in various critical illnesses. However, its association with mortality in critically ill patients with T2DM remains unclear. This study aims to evaluate the predictive value of LAR for prognosis in this specific patient population through a retrospective analysis. Methods: This retrospective observational cohort study utilized data from the Medical Information Mart for Intensive Care IV (MIMIC‐IV) v3.0 database, which includes complete medical records of patients admitted to the intensive care unit (ICU) of a U.S. medical center between 2008 and 2022. Subjects were categorized into three groups based on LAR tertiles. The study assessed ICU mortality and in‐hospital mortality as primary outcomes; 30‐day, 90‐day, and 365‐day mortality after ICU admission served as secondary outcomes. Machine learning identified key variables related to LAR and outcomes. The association between LAR and primary outcomes was analyzed using multivariate logistic regression and restricted cubic spline (RCS) regression. Cumulative mortality was analyzed using Kaplan–Meier curves. Threshold effects were evaluated using generalized additive models to enhance clinical applicability. Sensitivity and subgroup analyses were used to validate the robustness of the results and the interactions within subgroups. Result: The study included 5463 critically ill T2DM patients. Using Boruta and SHapley Additive exPlanations (SHAP) algorithms, 14 key variables were identified. RCS analysis revealed a nonlinear relationship between LAR and in‐hospital mortality (p for nonlinearity = 0.001). Threshold effect analysis identified a critical LAR threshold of 2.10. Kaplan–Meier survival curves showed that higher LAR values were correlated with increased mortality (p < 0.001). Subgroup analyses revealed significant interactions in gender subgroups for ICU mortality (p for interaction = 0.043) and in hyperlipidemia (HLD) subgroups for in‐hospital mortality (p for interaction = 0.049). Sensitivity analyses confirmed robust associations between LAR and ICU mortality (OR 1.32, 95% CI: 1.20–1.45, p < 0.001) and in‐hospital mortality (OR 1.37, 95% CI: 1.26–1.50, p < 0.001). Conclusion: This study identified a significant correlation between elevated LAR and adverse ICU outcomes in critically ill patients with T2DM. [ABSTRACT FROM AUTHOR]
ISSN:20902840
DOI:10.1155/emmi/2751114