Sex-stratified early biomarker model identifies lactate as the key predictor of in-hospital deterioration in acute heart failure

In this single-center AHF cohort, lactate emerged as the most consistent early biomarker associated with in-hospital deterioration, with stronger prognostic performance than the other evaluated cardiac markers. Sex-stratified and phenotype-specific findings (NT-proBNP and lactate in men, NLR in non-HFrEF) were exploratory and did not show significant sex-biomarker interaction. These results support incorporating lactate into early risk stratification and highlight the need for larger multicenter validation studies.