Early prognostic value of the lactate-to-albumin ratio in severe acute pancreatitis with acute respiratory distress syndrome

BackgroundAcute respiratory distress syndrome (ARDS) secondary to severe acute pancreatitis (SAP) is associated with high mortality; however, dependable biomarkers for early risk assessment remain scarce. The lactate-to-albumin ratio (LAR), reflecting both metabolic stress and nutritional status, may serve as a useful prognostic indicator in critical illness.MethodsThis retrospective study included 351 SAP patients with ARDS who were admitted to the intensive care unit of a tertiary hospital from 2016 to 2024. Clinical and laboratory data within 24 h of admission were collected. The primary outcome was in-hospital mortality. A logistic regression analysis was performed to identify independent predictors, and receiver operating characteristic (ROC) curves were used to compare the prognostic performance of LAR, lactate, albumin, and Sequential Organ Failure Assessment (SOFA) scores.ResultsIn-hospital mortality was 23.6% (83/351). Non-survivors had significantly higher LAR levels than survivors (p < 0.001). After adjusting for confounders, LAR remained independently associated with mortality (OR = 1.32, 95% CI: 1.04–1.67, p = 0.024). ROC analysis showed that LAR outperformed albumin and achieved accuracy comparable to lactate and SOFA. High LAR (≥1.32) was associated with lower 28-day survival (p < 0.001). A threshold effect was identified at LAR = 1.78.ConclusionLAR is an independent predictor of in-hospital mortality in SAP patients with ARDS. As a simple, rapid, and cost-effective biomarker, LAR may facilitate early risk stratification and clinical decision-making.