Lactate-to-glucose ratio and short-term all-cause mortality in critically ill cirrhosis patients: a MIMIC-IV and eICU-CRD database study

Patients with advanced cirrhosis are at an elevated risk of mortality, underscoring the need for reliable prognostic markers. This study aims to evaluate the association between the lactate-to-glucose ratio (LGR) and all-cause mortality in critically ill patients with cirrhosis, providing insights into potential predictive indicators in this high-risk population. This study investigated the association between the LGR and mortality risk in critically ill cirrhotic patients using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v3.1) and the eICU Collaborative Research Database (eICU-CRD). First, variable importance was assessed using the Boruta feature selection algorithm. Multivariable Cox regression was applied to examine the relationship between LGR and short-term mortality in critically ill cirrhotic patients, followed by risk stratification using X-tile software. Survival outcomes were evaluated via Kaplan-Meier (KM) analysis, while diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Additionally, restricted cubic spline (RCS) regression was utilized to explore potential non-linear associations, and subgroup interaction analyses were performed. This retrospective study analyzed 3,366 patients from MIMIC and 478 from eICU-CRD, with ICU mortality rates of 27.75% and 21.96%, respectively. Using 30-day mortality data from MIMIC, we applied the Boruta Based Feature Importance Analysis to confirm LGR’s prognostic value and established an optimal cutoff of 0.68 via X-tile (high-risk: LGR ≥ 0.68; low-risk: LGR < 0.68). Multivariate Cox regression revealed LGR as an independent mortality predictor in cirrhotic patients (P < 0.001), corroborated by K-M analysis showing reduced high-risk survival (P < 0.001). ROC curves indicated moderate short-term mortality prediction, while restricted cubic spline analysis indicated a positive correlation between LGR and mortality. subgroup analyses revealed no significant interaction effects. LGR is associated with short-term mortality in ill patients with cirrhosis.