Association between lactate-to-albumin ratio and all-cause mortality in critically ill patients with nontraumatic cerebral hemorrhage: A retrospective cohort study

Nontraumatic cerebral hemorrhage (NCH) is a major cause of mortality and long-term disability in critically ill patients, and reliable prognostic biomarkers are required. The lactate-to-albumin ratio (LAR) is a validated prognostic indicator in critical care; however, its predictive value in NCH patients remains unclear. A retrospective cohort study using the Medical Information Mart for Intensive Care IV database enrolled 1010 intensive care unit (ICU)-admitted critically ill NCH patients, with LAR calculated from lactate and albumin levels within 24 hours of admission. The primary and secondary endpoints were the in-hospital and ICU mortality rates. Kaplan-Meier, log-rank tests, receiver operating characteristic analysis, univariate/multivariable Cox regression, restricted cubic splines, and subgroup analyses were used for relevant assessments. Median admission LAR was 0.47 (interquartile range: 0.33-0.70); in-hospital and ICU mortality rates were 26.63% and 27.13%. Elevated LAR was an independent correlate of both mortalities (P < .001), with a higher area under the curve for mortality prediction than lactate or albumin alone. LAR was consistently associated with mortality in most of the demographic and clinical subgroups. LAR reliably predicts in-hospital and ICU mortality in critically ill patients with NCH and may optimize early risk stratification and clinical management.