ArticleFrontiers in nutrition2026
The lactate-to-albumin ratio as a potential biomarker for acute kidney injury risk in critically ill patients with heart failure: a retrospective study with real-world external validation.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The lactate-to-albumin ratio (LAR) is a composite biomarker that integrates measures of nutritional status, systemic inflammation, and oxidative stress in critically ill patients. Although LAR has been validated as a predictor of acute kidney injury (AKI) in sepsis populations, its ability to identify AKI risk in the setting of heart failure has not been comprehensively evaluated. Methods: This investigation utilized the eICU Collaborative Research Database (eICU) as the internal derivation cohort, with an independent clinical cohort employed for external validation. Analytical methods included multivariable logistic and Cox proportional hazards regression, restricted cubic spline (RCS) modeling, and Kaplan-Meier survival curve analysis to examine the relationship between LAR levels and AKI as well as other adverse outcomes in patients with heart failure. The stability of the results was assessed Results: The final study population consisted of 5,288 patients with heart failure [median (interquartile range) age 71.0 years (61.0, 80.0); 54.3% male]. The overall AKI incidence in this critically ill heart failure cohort was 23.1%. After multivariable adjustment, elevated LAR levels remained independently associated with increased AKI risk in both the primary and external validation cohorts. Patients in the highest LAR quartile (Q4) had an AKI incidence of 28.8%, compared with 18.4% in the lowest quartile (Q1), with an adjusted OR of 1.77 (95% CI 1.45-2.16; Conclusions: This cohort study identifies elevated LAR as an independent risk factor for AKI in patients with heart failure. Further prospective validation is needed to establish its clinical value for risk stratification in this population.
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