Association between lactate dehydrogenase-to-albumin ratio and short-term mortality in critically ill patients with urosepsis: evidence from dual retrospective cohorts.

Authors

Guangyou Yang, Kunyuan Huang, Haoming Luo, Xinxin Peng

Published in

Frontiers in cellular and infection microbiology. Volume 16. Pages 1891664. Epub Sep 16, 2026.

Abstract

The lactate dehydrogenase-to-albumin ratio (LDAR) reflects tissue damage, inflammation, and nutritional status. Its prognostic value in urosepsis remains unexplored. We evaluated LDAR's association with short-term mortality and developed an LDAR-based prediction model.
This retrospective dual-cohort study used MIMIC-IV (n=3,060) and an external cohort (n=370). Exposure was log₂-transformed LDAR (logLDAR); outcomes were 28-day intensive care unit (ICU) and in-hospital mortality. Cox regression with three adjustment models, restricted cubic splines (RCS), and Kaplan-Meier curves assessed associations; Fine-Gray models addressed competing risks. DeLong tests compared area under the curve (AUC) of six conventional scores with and without logLDAR. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) quantified incremental value of adding logLDAR; Machine learning selected predictors for a parsimonious model validated internally and externally. decision curve analysis (DCA) evaluated the 7-variable model's utility.
Among 3,060 patients, higher logLDAR was associated with significantly elevated 28-day ICU (23.4% vs. 9.02%) and in-hospital (22.1% vs. 8.24%) mortality (both P<0.001). In the primary multivariable-adjusted model, per-unit increases in logLDAR yielded hazard ratios (HRs) of 1.26 (95% CI: 1.17-1.36) for ICU mortality and 1.35 (95% CI: 1.25-1.45) for in-hospital mortality. Compared with the lowest tertile, the highest tertile showed HRs of 1.79 (1.40-2.30) and 2.29 (1.77-2.96), respectively. RCS analysis revealed linear dose-response relationships (P<0.001), and the Fine-Gray model confirmed robust associations (subdistribution hazard ratio (sHR)=1.36, 1.27-1.46). Adding logLDAR significantly improved the AUCs of all six conventional scores (DeLong P<0.01), with NRI/IDI showing substantial reclassification improvement (P<0.001). A parsimonious 7-variable model achieved AUCs of 0.674, 0.677, and 0.783 in the internal training, internal validation, and external cohorts, respectively, with adequate calibration (Hosmer-Lemeshow P > 0.05) and DCA demonstrating net clinical benefit. These findings were fully validated in an external real-world cohort.
LDAR independently predicts short-term mortality in critically ill patients with urosepsis, supplementing conventional severity scores. The parsimonious risk model showed moderate performance with acceptable cross-cohort generalizability.

PMID:
42819091
Bibliographic data and abstract were imported from PubMed on 02 Oct 2026.

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