Lactate‑to‑albumin ratio as an independent predictor of short‑ and long‑term mortality in ICU patients with malignant tumors: A retrospective cohort study

Lactate‑to‑albumin ratio (LAR) may reflect metabolic dysregulation and nutritional status in critically ill patients. However, its association with long‑term prognosis in intensive care unit (ICU) patients with malignant tumors requires further elucidation. The present study was conducted to assess the association between LAR and 30‑day and 360‑day all‑cause mortality in ICU patients with malignant tumors and to investigate the potential non‑linear associations and subgroup differences. A total of 1,634 ICU patients with malignant tumors were enrolled. Baseline clinical data were collected and LAR was calculated. Survival differences across LAR tertiles were analyzed using Kaplan‑Meier curves with the log‑rank test. Univariate and multivariate Cox regression models (with stepwise adjustment for confounders) were employed to evaluate the independent predictive value of LAR for all‑cause mortality. A restricted cubic spline model was used to analyze the non‑linear association and subgroup interaction tests were conducted to verify the stability of the LAR effect. The 30‑day mortality rates for the three tertile groups were 23, 31 and 43%, respectively, while the 360‑day mortality rates were 51, 56 and 67%. Mortality significantly increased with higher LAR tertiles (P<0.001). Multivariate Cox regression analysis, after adjusting for confounders, identified LAR as an independent risk factor for both 30‑day [hazard ratio (HR)=1.13; 95% CI: 1.04‑1.22; P=0.004] and 360‑day (HR=1.15; 95% CI: 1.07‑1.23; P<0.001) all‑cause mortality. Restricted cubic spline analysis indicated a linear association between LAR and mortality risk. Subgroup analysis revealed no significant interaction effects. Overall, LAR was identified to be an independent predictor of 30‑day and 360‑day all‑cause mortality in ICU patients with malignant tumors, exhibiting a linear positive association with mortality risk. Its predictive effect remains stable across different subgroups, suggesting its potential as a prognostic indicator in this patient population.