# Lactate/albumin ratio predicts 90-day mortality of cardiogenic shock patients

## TL;DR

This study finds that the lactate/albumin ratio (LAR) can predict 90-day mortality in cardiogenic shock patients, with higher LAR values indicating worse outcomes.

## Contribution

The study introduces the LAR as a novel prognostic marker for cardiogenic shock mortality with a defined threshold of 0.094.

## Key findings

- An LAR greater than 0.094 is associated with significantly higher 90-day mortality in cardiogenic shock patients.
- LAR has better predictive performance than lactate or albumin levels alone in predicting mortality.
- LAR is a linear and independent predictor of mortality in cardiogenic shock patients.

## Abstract

Serum lactate and albumin levels upon admission are independent risk factors for poor prognosis in patients with cardiogenic shock (CS). The association between the serum lactate/albumin ratio (LAR) and mortality in patients with cardiogenic shock remains unclear. This study aims to explore the relationship between LAR at admission and the 90-day mortality of patients with CS.

We performed a secondary analysis of previously published data on cardiogenic shock patients. Based on the curve, an LAR of >0.094 indicated a harmful threshold. The outcomes of cardiogenic shock Patients dichotomized according to the LAR cut-off value. Univariate logistic regression models, the receiver operating characteristic (ROC) curve in the multivariate analysis, a restricted cubic spline plot derived from multivariate logistic regression, Decision curve analysis and subgroup analyses were employed to investigate the association between LAR and mortality of cardiogenic shock.

A total of 176 patients were included. Univariate logistic analyses revealed a positive association between LAR and 90-day mortality of cardiogenic shock patients (HR 4.50, 95 % CI=2.64–7.66, p<0.001). The Area Under the Curve (AUC) value for LAR was 0.781 (95 % CI: 0.713–0.848), which was higher than that for initial lactate (AUC=0.768) and albumin (AUC=0.652) alone. It was not inferior even when compared to IABP-SHOCK II score (AUC=0.719). The restricted cubic spline analysis demonstrated a linear relationship between baseline LAR and the mortality of patients with cardiogenic shock. The Kaplan-Meier curves indicate lower survival rates in patients with LAR values >0.094. Decision curve analysis shows that LAR model has the best utility in intermediate-risk clinical decisions (30–75 % threshold). The final subgroup analysis showed no significant interaction of LAR with each subgroup (P for interaction: 0.057–0.948).

The baseline Lactic/albumin Ratio (LAR) in patients experiencing cardiogenic shock shows a positive correlation with mortality associated with this condition. The findings indicate a significant increase in the mortality rate when the LAR exceeds a certain threshold. Furthermore, the LAR serves as an independent risk factor for poor prognosis in patients suffering from cardiogenic shock, with superior prognostic performance than initial lactate or serum albumin alone. Clinicians use LAR for personalized risk assessment when they encounter a medium probability scenario for 90-day mortality.