Association between lactate-to-albumin ratio and 28-day all-cause mortality in critically ill patients with chronic kidney disease: A retrospective cohort study from the Medical Information Mart for Intensive Care IV database

Objective The lactate-to-albumin ratio has been associated with adverse outcomes in various diseases. However, the impact of the lactate-to-albumin ratio on the prognosis of critically ill patients with chronic kidney disease remains unclear. Therefore, this study aimed to investigate the predictive ability of the lactate-to-albumin ratio for 28-day all-cause mortality in critically ill patients with chronic kidney disease. Methods This retrospective cohort study included 4271 critically ill patients with chronic kidney disease from the Medical Information Mart for Intensive Care IV database. The exposure factor was the lactate-to-albumin ratio, and the outcome was the 28-day mortality rate. Hazard ratios were computed along with their corresponding 95% confidence intervals using multivariate Cox regression. Results Multivariable Cox regression revealed that, compared with the Tertile 1 group, the hazard ratio for 28-day mortality was 1.55 (95% confidence interval: 1.26–1.92, p < 0.001) in the Tertile 2 group and 1.91 (95% confidence interval: 1.54–2.36, p < 0.001) in the Tertile 3 group. Kaplan–Meier analysis demonstrated that the higher lactate-to-albumin ratio group had higher 28-day, 90-day, and 1-year mortality rates ( p < 0.001). Conclusions In our study population, the lactate-to-albumin ratio was independently associated with 28-day all-cause mortality, and this ratio may provide incremental prognostic value when combined with established severity of illness scores.