ArticleFrontiers in cellular and infection microbiology2026
Association between lactate dehydrogenase-to-albumin ratio and short-term mortality in critically ill patients with urosepsis: evidence from dual retrospective cohorts.
Article in Frontiers in cellular and infection microbiology, 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 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. Methods: This retrospective dual-cohort study used MIMIC-IV (n=3,060) and an external cohort (n=370). Exposure was log Results: 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. Conclusions: 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.
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