Association between lactate-to-albumin ratio and in-hospital mortality in ICU patients with acute ischemic stroke: a retrospective cohort study

Abstract

Background Early risk stratification is critical for critically ill patients with ischemic stroke. The prognostic value of the lactate-to-albumin ratio (LAR) remains unclear in this population. Methods This single-center retrospective cohort study enrolled adult ICU patients with ischemic stroke from West China Hospital. LAR was calculated using the first lactate and albumin values on ICU admission. Log-transformed LAR was adopted as the main exposure, and the primary outcome was in-hospital mortality. Multivariable logistic regression, ROC analysis, quartile stratification, subgroup, and sensitivity analyses were performed among 749 patients with complete exposure and outcome data, of whom 576 had complete covariate data and comprised the primary multivariable regression cohort. Results A total of 749 patients were included, with an in-hospital mortality rate of 30.7%. In complete-case multivariable analysis (N = 576; deaths = 172), log-transformed LAR was independently associated with in-hospital mortality (OR = 1.44, 95%CI: 1.09–1.91, p = 0.010) after full adjustment. Each two-fold increase in LAR was associated with a 29% increase in mortality odds. The highest LAR quartile had a significantly higher mortality risk than the lowest quartile (OR = 2.16, 95%CI: 1.21–3.92). LAR showed modest predictive ability (AUC = 0.628). When modeled as a raw continuous LAR, the direction of association remained consistent but did not reach conventional statistical significance (OR 1.23; 95% CI 0.97–1.56; p = 0.083). Moreover, no significant interaction or non-linearity was found. Conclusion Elevated LAR is independently linked to higher in-hospital mortality among critically ill ischemic stroke patients. It may serve as a simple adjunctive marker for early risk stratification.