The predictive value of the lactate dehydrogenase-to-albumin ratio for mortality in patients with septic shock

Septic shock is a life-threatening condition with high mortality despite advances in intensive care. Identifying reliable and easily obtainable biomarkers is essential for early risk stratification. Lactate dehydrogenase-to-albumin ratio (LAR), which combines 2 routine laboratory tests, has recently been suggested as a prognostic marker in sepsis. To investigate the predictive value of LAR for 28-day mortality in patients with septic shock. This retrospective study included 93 patients with septic shock admitted to the intensive care unit of the Second People's Hospital of Hefei. Patients were categorized into survival (n = 41) and non-survival (n = 52) groups based on their 28-day outcomes. Univariate and multivariate analyses were performed to compare demographics, clinical indicators, and treatments. A restricted cubic spline (RCS) model was used to assess the relationship between LAR and mortality. Patients were stratified into high- and low-LAR groups using the optimal cutoff identified by the RCS model. Kaplan-Meier survival curves and the log-rank test were used to compare 28-day survival between groups. Univariate analysis revealed significant differences between the survival and non-survival groups in terms of age, acute physiology and chronic health evaluation II score, Sequential Organ Failure Assessment score, intensive care unit length of stay, LAR, blood urea nitrogen, lactic acid, white blood cell count, mechanical ventilation, and norepinephrine use. Multivariate analysis identified LAR and white blood cell count as independent risk factors for mortality. RCS analysis demonstrated a nonlinear relationship between LAR and all-cause mortality, with a hazard ratio of 1 at a LAR value of 10.1. Patients in the high-LAR group (≥10.1) had significantly lower 28-day cumulative survival compared to those in the low-LAR group (<10.1; P = .011). LAR is an independent predictor of 28-day mortality in patients with septic shock, with higher values associated with increased risk. Patients with elevated LAR (≥10.1) should be closely monitored. However, as this was a retrospective single-center study with a relatively small sample size, the findings should be interpreted cautiously, and larger prospective studies are warranted.