ArticleBMC cancer2025
Association between the lactate dehydrogenase-to-albumin ratio and 28-day mortality in septic patients with malignancies: analysis of the MIMIC-IV database.
Article in BMC cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.
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9 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Association between elevated multiple circulating biomarkers and short-term mortality in critically ill lung cancer patients: a meta-analysis.Frontiers in oncology · 2026Pooled it
- Association of lactate dehydrogenase to albumin ratio with new-onset acute respiratory distress syndrome and all-cause mortality in patients with sepsis: a retrospective cohort study based on the MIMIC-IV database.BMC infectious diseases · 2026Article
- Log odds of positive lymph nodes predict surgical prognosis in intrahepatic cholangiocarcinoma based on SEER cohort and nomogram model.Discover oncology · 2026Article
- Association between baseline-stratified trajectory subgroups of serum albumin and outcomes in critically ill patients with early sepsis-associated acute kidney injury: a retrospective study.Frontiers in medicine · 2026Article
- Lactate dehydrogenase-to-albumin ratio as a potential prognostic indicator in glucocorticoid-treated severe pneumonia: a multicenter retrospective study with external validation.Frontiers in immunology · 2026Article
- Early lactate dynamics for short-term mortality in emergency department sepsis.BMC emergency medicine · 2025Observational
- Prospective Evaluation of Clinical and Laboratory Profiles of Febrile and Afebrile Immunosuppressed Patients Presenting to the Emergency Department.Medicina (Kaunas, Lithuania) · 2025Article
- Establishment and validation of a 28-day mortality prediction model based on the lactate dehydrogenase/albumin ratio in patients with severe pneumonia.Frontiers in medicine · 2025Article
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Abstract
backgroundSepsis remains a leading cause of mortality in critically ill patients, particularly those with malignancies who face heightened risks due to immunosuppression and metabolic dysregulation. This study aimed to evaluate the prognostic value of the lactate dehydrogenase-to-albumin ratio (LDAR) for predicting 28-day ICU mortality in septic patients with malignancies.
methodsA retrospective cohort analysis was conducted using data from 1,635 septic patients with malignancies in the MIMIC-IV (3.1) database. Participants were stratified into quartiles based on LDAR values. The primary outcome was 28-day ICU mortality, with secondary outcomes including in-hospital and ICU mortality. Multivariable logistic regression, restricted cubic spline (RCS) analysis, and machine learning models were employed to assess associations between LDAR and outcomes. Subgroup analyses and feature importance evaluations were performed to validate robustness. The Shapley additive explanations method was used to enhance model interpretability and assess individual predictor contributions.
resultsHigher LDAR is independently associated with increased 28-day ICU mortality (OR: 3.441, 95% CI: 2.497-4.741), ICU mortality (OR: 3.478, 95% CI: 2.396-5.049), and in-hospital mortality (OR: 3.747, 95% CI: 2.688-5.222), even after adjustment, highlighting its potential as a prognostic marker in ICU patients. RCS analysis revealed a nonlinear relationship, with mortality risk escalating sharply beyond log₂(LDAR) = 6.940. Metastatic cancer patients had higher median LDAR (135.0 vs. 118.5, P = 0.004) and mortality rates (52.0% vs. 36.4%, P < 0.001). Boruta feature selection showed that LDAR as the top predictor of mortality. Nine machine learning model with 20 variables were built, with random forest model performing best, achieving an AUC of 0.751 (0.708-0.794) in validation and 0.727 (0.682- 0.772) in text cohort.
conclusionsLDAR is a robust, independent prognostic biomarker for 28-day ICU mortality in septic patients with malignancies, outperforming traditional scoring systems. The identified threshold (log₂(LDAR) ≥ 6.940) may aid early risk stratification and clinical decision-making. Prospective studies are warranted to validate these findings and explore dynamic LDAR monitoring in diverse populations.
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