Sepsis-induced coagulopathy (SIC) is a severe complication of sepsis that carries high mortality. The lactate dehydrogenase-to-albumin ratio (LAR) combines a marker of cellular injury and inflammation (lactate dehydrogenase) with nutritional/serum protein status (albumin). Prior work has linked components of this ratio and related ratios to sepsis outcomes, but the specific prognostic role of LAR in patients with SIC had not been fully characterized.
The study summarized here examined whether LAR measured in ICU patients with SIC is associated with short- and intermediate-term mortality, and whether that association is linear or demonstrates thresholds of increased risk.
Investigators performed a retrospective cohort analysis using the Medical Information Mart for Intensive Care (MIMIC) database. The analytic cohort comprised 1,500 patients meeting criteria for sepsis-induced coagulopathy drawn from MIMIC.
Patients were categorized into low-, medium-, and high-LAR groups for comparison. The report used survival analysis methods to compare outcomes between groups and to evaluate adjusted associations.
The primary outcome was 30-day all-cause mortality. The secondary outcome was 90-day mortality. To assess associations between LAR and outcomes, the investigators used Kaplan–Meier survival curves and Cox proportional hazards regression models. They applied natural-log transformation of LAR (ln(LAR)) for regression analyses. Restricted cubic splines were used to evaluate non-linear associations, and subgroup analyses were performed to explore effect modification.
When patients were stratified by LAR category, both the medium- and high-LAR groups had significantly higher 30-day and 90-day mortality compared with the low-LAR group (reported p < 0.001 for these comparisons). This indicates an unadjusted association between increasing LAR category and higher short- and intermediate-term mortality in SIC.
In fully adjusted Cox regression models using ln(LAR) as a continuous predictor, ln(LAR) was positively associated with mortality. Specifically, ln(LAR) was associated with increased 30-day mortality (hazard ratio [HR] = 1.17, 95% confidence interval [CI] 1.03–1.31, p = 0.013) and increased 90-day mortality (HR = 1.17, 95% CI 1.04–1.30, p = 0.007). These findings persisted after adjustment for covariates included in the fully adjusted model.
Restricted cubic spline analysis indicated that the relationship between ln(LAR) and 30-day mortality was non-linear (P-non-linear = 0.007). The analysis identified an inflection point at ln(LAR) = 4.57. The authors report that prognosis was notably worse once ln(LAR) exceeded this value, implying a threshold effect rather than a strictly linear association across the full LAR range.
Subgroup analyses were performed to identify potential effect modification across study populations. The investigators observed a statistically significant interaction for dobutamine therapy (P-interaction = 0.03), indicating that the association between ln(LAR) and mortality varied by whether patients received dobutamine. Details on the direction or magnitude of the interaction within specific subgroups were not provided in the abstract.
In this retrospective cohort of ICU patients with sepsis-induced coagulopathy from the MIMIC database, a higher lactate dehydrogenase-to-albumin ratio (LAR) was associated with worse 30- and 90-day survival. The association remained significant after multivariable adjustment, and a non-linear relationship with an inflection at ln(LAR) = 4.57 was identified, suggesting elevated risk above that threshold. An interaction with dobutamine use was reported.
These findings suggest that LAR may serve as a prognostic biomarker in SIC and that clinicians and researchers could consider the ratio when stratifying risk in this population. The identified inflection point may help define patients at particularly high risk.
The source material is an abstract and does not report full methodological details such as specific adjustment covariates, criteria used to define SIC in MIMIC, baseline characteristics of LAR groups, absolute mortality rates by group, or the detailed results of subgroup analyses beyond the dobutamine interaction p-value. The abstract format also does not provide information about missing data handling, timing of LAR measurement relative to ICU admission, or external validation. These details were not reported in the source and would require consultation of the full paper for clarification.