Front Nutr. 2026 Jul 31;13:1874267. doi: 10.3389/fnut.2026.1874267. eCollection 2026.
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 via prespecified subgroup analyses, interaction testing, and multiple sensitivity analyses.
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; p < 0.001). Subgroup analyses identified statistically significant interactions for body mass index (obese vs. non-obese), chronic kidney disease (present vs. absent), and SOFA score (≥6 vs. <6), with no other significant interactions observed. RCS analysis demonstrated a non-linear dose-response relationship between LAR and AKI, with AKI risk increasing in parallel with rising LAR levels (p for overall association < 0.001, p for non-linearity = 0.014). Kaplan-Meier cumulative risk analysis confirmed significant differences in AKI incidence across LAR quartiles (log-rank p < 0.001). In secondary outcome analyses, higher LAR was not associated with CRRT utilization or new-onset atrial fibrillation (NOAF), but showed an inconsistent association with increased in-hospital mortality between the two cohorts.
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.
PMID:42601917 | PMC:PMC13472818 | DOI:10.3389/fnut.2026.1874267