Association Between Lactate-to-albumin Ratio and 28-day Mortality in Patients with Ventilator-associated Pneumonia

<i>Background:</i> Ventilator-associated pneumonia (VAP) is a frequent complication for those receiving invasive mechanical ventilation in the ICU, exerts significant impacts on clinical outcomes. We aimed to explore the association between LAR and 28-day mortality in those suffering from VAP. <i>Methods:</i> This investigation utilized clinically granular data from MIMIC-IV database. Altogether, 591 patients with VAP were ultimately collected for analysis. Participants were categorized into three groups in accordance with tertiles of LAR. The key clinical endpoint was 28-day all-cause mortality. Univariate Cox Regression, Multivariate Cox Regression, RCS (Restricted cubic spline), Kaplan–Meier curve, and Subgroup analyses were used to examine the association between LAR and 28-day mortality among critical care patients with VAP. <i>Results: </i>Of the VAP patients, 22.0% succumbed within the 28-day observational window. According to the multivariable Cox regression analysis, LAR independently influenced the 28-day mortality risk in VAP patients (adjusted HR = 1.22, 95% CI: 1.06~1.39, P = 0.005). Restricted cubic spline analysis revealed a positive correlation between LAR and 28-day mortality. Subgroup analyses confirmed consistent associations across diverse patient characteristics. Kaplan-Meier curves demonstrated that patients in the high-LAR group had significantly lower survival probabilities compared to the low- and medium-LAR groups, suggesting that patients with VAP who have elevated LAR face a greater risk of mortality within 28 days. <i>Conclusion:</i> In summary, our study revealed a positive dose-response association between LAR and 28-day mortality in patients with VAP, suggesting that LAR is identified as an independent risk factor for unfavorable clinical outcomes in this population.