Elevated Lactate-to-Albumin Ratio: A Critical Predictor of Adverse Outcomes in Coronary Syndrome

Aim: Acute coronary syndrome (ACS) encompasses a range of life-threatening conditions, including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), in which early mortality continues to pose a significant challenge. Prompt recognition of high-risk patients is crucial to enable timely interventions that may enhance survival outcomes. Current prognostic tools may not be sufficient for early risk assessment. The lactate-albumin ratio (LAR) is a promising, cost-effective marker that could help predict early mortality in ACS patients, enabling better risk stratification and improving clinical outcomeMaterial and Methods: This retrospective, single-center study included 200 hospitalized patients, comprising 100 with STEMI and 100 with NSTEMI. Laboratory analyses were performed on blood samples and arterial blood gas measurements obtained at the time of admission. In-hospital mortality and arrhythmia rates were compared between the groups based on the lactate-albumin ratio.Results: LAR levels were compared based on mortality status. The median (IQR) LAR for deceased patients was 1.13 (0.53–1.30), significantly higher than that of surviving patients [median (IQR) LAR: 0.41 (0.32–0.54), p < 0.001]. At a cut-off value of 0.89, LAR had 73.3% sensitivity and 97.3% specificity for predicting mortality. Logistic regression analysis confirmed LAR as a strong predictor of mortality (Nagelkerke R² = 45.5%, B = 5.78, OR = 323, 95% CI: 35.45–2956, p < 0.001).Conclusion: In acute coronary syndrome, the lactate–albumin ratio may serve as a practical biomarker for early risk stratification and identification of high-risk patients rather than as a diagnostic tool.