The correlation of lactate/albumin ratio and their association for short-term and long-term mortality in patients with acute aortic dissection

Objective: The direct impact on survival of lactate-to-albumin ratio (LAR) in acute aortic dissection (AAD) remains uncertain.Methods: Medical electric records of 919 patients in the intensive care unit (ICU) who diagnosed with AAD were extracted from the MIMIC-IV database.These patients were subsequently divided into quartiles according to their LAR.Multivariable Cox regression incorporating restricted cubic spline terms was applied to examine how LAR relates to all-cause death at 30-, 90-, and 365-day intervals after ICU admission.To probe possible nonlinearities, we used smoothed curve analyses and fitted segmented (2-piece) linear models where appropriate.Results: Kaplan-Meier curves showed progressively poorer survival among patients in the highest LAR quartile.Multivariable Cox proportional-hazards analysis shown the greatest quartile exhibited adjusted hazard ratios of 1.329 (95% confidence interval [CI], 1.118-1.579)at 30 days, 1.314 (95% CI, 1.130-1.527)at 90 days and 1.263 (95% CI, 1.096-1.455)at 365 days compared with the lowest quartile.Restricted cubic spline modeling revealed a positive association between increasing LAR and mortality risk in critically ill patients with AAD.Consistent patterns emerged across all clinically relevant subgroups.Smooth-curve fitting suggested a nonlinear relationship between LAR and mortality risk; subsequent piecewise linear regression identified inflection points for all-cause death at 30, 90, and 365 days of 0.769, 0.385, and 0.381, respectively. Conclusions: Even after multivariable adjustment, the LAR demonstrated a robust association with all-cause mortality at 30, 90, and 365 days in patients with AAD in the ICU.(JTCVS Open 2026;:101568) MIMIC-IV Database 919 AAD patients 2008-2019 Two Cox proportional hazards models Restricted cubic spline analysis 0 1 2 3 4 0 LAR Hazard ratio (95% CI) 1 2 3 4 5 6 A 7 P for overall < .001P for nonlinear = .0130 1 2 3 4 5 0 LAR Hazard ratio (95% CI) 1 2 3 4 5 6 B P for overall < .001P for nonlinear = .0030 1 2 3 4 5 0 LAR Hazard ratio (95% CI) 1 2 3 4 5 C P for overall < .001P for nonlinear = .017LAR demonstrated a robust association with allcause mortality in ICU patients with AAD. CENTRAL MESSAGEUsing the MIMIC-IV database, this study is the first, to our knowledge, to investigate the association between admission LAR and all-cause mortality in patients with AAD. PERSPECTIVEThis study demonstrated that the LAR's prognostic value persisted after rigorous adjustment, including for established severity scores, underscoring its potential as a readily available bedside tool to enhance risk stratification and long-term prognosis assessment in AAD, addressing a significant unmet need in the field. See Commentary on page XXX.Acute aortic dissection (AAD) is the most frequent occurring acute aortic disease, with an annual incidence of 3 to 16 cases per 100,000. 1 Although the survival rate after AAD or rupture already is significantly increased by immediate surgical intervention, the postoperative 30-day mortality rates are still 11.8% to 30% for those who are treated with a modern surgical strategy. 2Emergency events, including coma, shock, malperfusion, and cardiac tamponade, have been confirmed as the classic predictive factors for postoperative mortality. 3,4However, a key challenge for prognostic tools is to distinguish patients with worse clinical outcomes from others, especially the short-term and long-term mortality of individuals who survive the acute period, because both types of patients receive similar modern surgical strategies.Indeed, some studies have shown that inflammation biomarkers such as C-reactive protein, D-dimer, and the ratio of specific blood cells may predict