Objective: To investigate the predictive value of the arterial blood lactate to serum albumin ratio (LAR) on in-hospital mortality of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU).
Methods: Clinical datasets of 1720 CAP patients admitted to ICU from MIMIC-IV database were retrospectively analyzed. Patients were randomly assigned to the training cohort (n=1204) and the validation cohort (n=516) in a ratio of 7:3. X-tile software was used to find the optimal cut-off value for LAR. The receiver operating curve (ROC) analysis was conducted to compare the performance between LAR and other indicators. Univariate and multivariate Cox regression analyses were applied to select prognostic factors associated with in-hospital mortality. Based on the observed prognostic factors, a nomogram model was created in training cohort, and the validation cohort was utilized to further validate the nomogram.
Results: The optimal cut-off value for LAR in CAP patients admitted to ICU was 1.6 (the units of lactate and albumin were, respectively, 'mmol/L' and 'g/dL'). The ROC analysis showed that the discrimination abilities of LAR were superior to other indicators except Sequential Organ Failure Assessment score and Simplified acute physiology score (SAPSII), which had the same abilities. Age, mean arterial pressure, SpO2, heart rate, SAPSII score, neutrophil-to-lymphocyte ratio, and LAR were found to be independent predictors of poor overall survival in the training cohort by multivariate Cox regression analysis and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram model, exhibiting medium discrimination, had a C-index of 0.746 (95% CI = 0.715-0.777) in the training cohort and 0.716 (95% CI = 0.667-0.765) in the validation cohort.
Conclusion: LAR could predict in-hospital mortality of patients with CAP admitted to ICU independently as a readily accessible biomarker. The nomogram that included LAR with other independent factors performed well in predicting in-hospital mortality.
Keywords: Intensive Care Unit; Lactate to albumin ratio; community-acquired pneumonia; in-hospital mortality; prognosis.