Lactate-to-albumin ratio independently predicts mortality in hypertensive patients with atrial fibrillation

1. The lactate-to-albumin ratio was an independent predictor of 28-day mortality in hypertensive patients with atrial fibrillation. 

Evidence Rating Level: 2 (Good)

Atrial fibrillation (AF) is the most common arrhythmia in critically ill patients. Patients with hypertension and AF present with greater clinical severity, which complicates prognosis. As traditional prognostic indicators may not fully capture the complexity of this condition, lactate-to-albumin ratio (LAR), a composite marker of metabolic stress and nutritional status, has been proposed to enhance prognostic precision. The role of LAR had been studied in general intensive care unit (ICU) populations, but not specifically in critically ill hypertensive patients with AF. This study investigated the association between LAR and mortality in hypertensive patients with AF. This retrospective cohort study used data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database between 2008 and 2022 and included hypertensive patients >18 with AF and LAR values obtained within the first 24 h after ICU admission. Patients were divided into two groups based on 28-day in-hospital survival: a survivor group and a nonsurvivor group. The primary endpoint was mortality within 28 days of ICU admission. Out of the 1087 patients included in the study (mean [SD] age = 76.78 [11.35], 478 [43.97%] female), 839 survived while 248 did not, resulting in a 28-day mortality rate of 22.8%. Compared with survivors, nonsurvivors had higher LAR values (0.74 vs. 0.52, p < 0.001). Increase in LAR was independently associated with greater risk of 28-day mortality (adjusted HR 1.03, 95% CI 1.01–1.06). Additionally, LAR had superior predictive ability (area under the curve [AUC] 0.661) compared with other biomarkers. Participants with high LAR (> 0.605) had a higher risk of mortality compared to those with low LAR (< 0.605) (HR 2.55, 95% CI 1.97–3.30). Overall, this study found that LAR is an independent predictor of short-term mortality in critically ill hypertensive patients with AF, highlighting its potential for risk assessment and tailored care in this population. Future studies with larger sample sizes are needed to confirm these results. 

Click to read this study in European Journal of Medical Research

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