Association of lactate to albumin ratio with the severity and prognosis of patients with sepsis admitted to the emergency intensive care unit: A prospective cohort study

The aim of this study is to evaluate the prognostic value of the lactate to albumin ratio (LAR) in predicting morbidity, acute kidney injury associated with sepsis (SA-AKI) and mortality in sepsis patients. This was a single-center prospective cohort study. All adult patients above the age of 18 with a diagnosis of sepsis who presented between January 1, 2024, and June 1, 2025, were included. The primary outcome was 28-day mortality, septic shock and SA-AKI. The patients were divided into non-shock group and shock group, non-acute kidney injury group and acute kidney injury group, survival group and death group for comparison. Group differences were significant based on LAR quartiles. Univariate and Logistic regression analyses showed that LAR was an independent risk factor for septic shock, septic acute kidney injury, and 28-day mortality. Elevated LAR stratification was associated with a significantly increased risk of shock, acute kidney injury, and 28-day mortality. LAR remained an independent risk factor for shock, acute kidney injury, and death when used as a continuous variable. Receiver operating characteristic (ROC) curve showed that the area under the curve (AUC) of septic shock was 0.705 (95% CI = 0.611-0.800) when the cutoff value of LAR was 0.106. When the cutoff value was 0.097, the AUC of sepsis-induced acute kidney injury was 0.762 (95% CI = 0.669-0.854). When the cutoff value was 0.098, the AUC of 28-day mortality was 0.863 (95% CI = 0.796-0.931). As the quartile of LAR layers increases, the risks of septic shock, SA-AKI and death gradually increased significantly. Early LAR has a certain predictive value for septic shock, SA-AKI and death outcomes.