Association of Lactate‐to‐Albumin Ratio With 28‐Day Mortality in Critically Ill Patients With Obstructive Sleep Apnea: A Retrospective Cohort Study Based on the MIMIC‐IV Database
- 1Department of Respiratory and Critical Care Medicine Yiwu Central Hospital Yiwu Zhejiang China ywzxyy.com
- 2Department of Laboratory Medicine Yiwu Central Hospital Yiwu Zhejiang China ywzxyy.com
Abstract
Background: Obstructive sleep apnea (OSA) is not uncommon among critically ill patients, especially in those with acute hypercapnic respiratory failure. Its high mortality rate remains a major challenge in the intensive care setting. The frequent apnea and respiratory failure during sleep in OSA patients, along with the intermittent hypoxemia caused by it, are accompanied by a series of systemic pathological and physiological changes. Metabolic imbalance is a key characteristic of the underlying pathological mechanism of this disease. However, the association between lactate‐to‐albumin ratio (LAR) and the prognosis of OSA patients remains to be fully elucidated. To date, a paucity of studies has evaluated the prognostic capabilities of these indicators. The majority of these studies have focused on the neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR), and the results are contradictory, insufficient to fully clarify their clinical significance. Relying solely on lactate may not fully reflect patients’ physiological conditions, whereas integrating LAR can provide a more comprehensive and accurate description of the metabolic state. This study aims to explore the relationship between LAR and 28‐day mortality rates in ICU patients with OSA, using data from the MIMIC‐IV database.
Methods: Patients diagnosed with OSA were selected from the Medical Information Mart for Intensive Care IV (v.2.2) database, identified by specific ICD‐9 and ICD‐10 codes (detailed in the Methods section). To assess the predictive power of LAR, receiver operating characteristic (ROC) curve analysis, Kaplan–Meier (K‐M) survival curve analysis, logistic regression analysis, and subgroup analysis were employed. LAR was analyzed both as a categorical variable (based on the optimal cutoff) and as a continuous variable.
Results: The sample population comprised 807 patients diagnosed with OSA who were admitted to the intensive care unit for the first time. The 28‐day mortality rate was 20.44%. The area under the ROC curve (AUC) for LAR was 0.730 (95% CI: 0.686–0.772), which was comparable with OASIS (0.736; 95% CI: 0.695–0.776) and superior to SOFA (0.637; 95% CI: 0.591–0.683; DeLong test p = 0.500). The optimal cutoff value for LAR was 0.791. The high‐LAR group demonstrated a poor prognosis in the K‐M analysis (p < 0.001). Multivariate logistic regression demonstrated a significant association between LAR and unfavorable outcomes, with an odds ratio (OR) of 3.00 (95% CI: 1.83–4.90, p < 0.001) when analyzed as a dichotomous variable, and an OR of 1.52 per unit increase (95% CI: 1.27–1.82, p < 0.001) when analyzed as a continuous variable. Subgroup analysis revealed no statistically significant interaction between LAR and any subgroup (p for interaction: 0.052–0.906).
Conclusion: LAR is a rational and easily accessible biomarker that is significantly associated with 28‐day mortality in ICU patients with OSA. These findings are only applicable to OSA patients who received lactate and albumin testing during ICU admission, and the results cannot be generalized to the entire population of ICU patients with OSA.
Related
- Association between platelet-to-white blood cell ratio trajectories and all-cause mortality in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease: a retrospective cohort study.
- Nonlinear association between cockcroft-gault creatinine clearance and all-cause mortality in critically ill cerebrovascular disease patients: a retrospective cohort study
- Association of Body Mass Index with Early Inflammatory and Coagulation Biomarker Patterns and Intensive Care Unit Mortality in Critically Ill Patients with COVID-19: A Retrospective Cohort Study
- Association of triglyceride-glucose index and triglyceride-glucose-body mass index with all-cause mortality in critically ill patients with aortic disease: A retrospective cohort study.
- Association between thymosin α1 therapy and 28-day mortality risk in critically ill patients with tuberculosis-related sepsis: a retrospective cohort study.
BibTeX
@article{zhou2026association,
title = {{Association of Lactate‐to‐Albumin Ratio With 28‐Day Mortality in Critically Ill Patients With Obstructive Sleep Apnea: A Retrospective Cohort Study Based on the MIMIC‐IV Database}},
author = {Jian Zhou and Chuntian Chi and Fanghao Yu and Junpei Wu and Hanjian Lou},
journal = {Canadian Respiratory Journal},
year = {2026},
month = nov,
doi = {10.1155/carj/6582764},
url = {https://doi.org/10.1155/carj/6582764},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association of Lactate‐to‐Albumin Ratio With 28‐Day Mortality in Critically Ill Patients With Obstructive Sleep Apnea: A Retrospective Cohort Study Based on the MIMIC‐IV Database
AU - Jian Zhou
AU - Chuntian Chi
AU - Fanghao Yu
AU - Junpei Wu
AU - Hanjian Lou
PY - 2026
DA - 2026/11/05
JO - Canadian Respiratory Journal
DO - 10.1155/carj/6582764
UR - https://doi.org/10.1155/carj/6582764
AB - Background: Obstructive sleep apnea (OSA) is not uncommon among critically ill patients, especially in those with acute hypercapnic respiratory failure. Its high mortality rate remains a major challenge in the intensive care setting. The frequent apnea and respiratory failure during sleep in OSA patients, along with the intermittent hypoxemia caused by it, are accompanied by a series of systemic pathological and physiological changes. Metabolic imbalance is a key characteristic of the underlying pathological mechanism of this disease. However, the association between lactate‐to‐albumin ratio (LAR) and the prognosis of OSA patients remains to be fully elucidated. To date, a paucity of studies has evaluated the prognostic capabilities of these indicators. The majority of these studies have focused on the neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR), and the results are contradictory, insufficient to fully clarify their clinical significance. Relying solely on lactate may not fully reflect patients’ physiological conditions, whereas integrating LAR can provide a more comprehensive and accurate description of the metabolic state. This study aims to explore the relationship between LAR and 28‐day mortality rates in ICU patients with OSA, using data from the MIMIC‐IV database. Methods: Patients diagnosed with OSA were selected from the Medical Information Mart for Intensive Care IV (v.2.2) database, identified by specific ICD‐9 and ICD‐10 codes (detailed in the Methods section). To assess the predictive power of LAR, receiver operating characteristic (ROC) curve analysis, Kaplan–Meier (K‐M) survival curve analysis, logistic regression analysis, and subgroup analysis were employed. LAR was analyzed both as a categorical variable (based on the optimal cutoff) and as a continuous variable. Results: The sample population comprised 807 patients diagnosed with OSA who were admitted to the intensive care unit for the first time. The 28‐day mortality rate was 20.44%. The area under the ROC curve (AUC) for LAR was 0.730 (95% CI: 0.686–0.772), which was comparable with OASIS (0.736; 95% CI: 0.695–0.776) and superior to SOFA (0.637; 95% CI: 0.591–0.683; DeLong test p = 0.500). The optimal cutoff value for LAR was 0.791. The high‐LAR group demonstrated a poor prognosis in the K‐M analysis (p < 0.001). Multivariate logistic regression demonstrated a significant association between LAR and unfavorable outcomes, with an odds ratio (OR) of 3.00 (95% CI: 1.83–4.90, p < 0.001) when analyzed as a dichotomous variable, and an OR of 1.52 per unit increase (95% CI: 1.27–1.82, p < 0.001) when analyzed as a continuous variable. Subgroup analysis revealed no statistically significant interaction between LAR and any subgroup (p for interaction: 0.052–0.906). Conclusion: LAR is a rational and easily accessible biomarker that is significantly associated with 28‐day mortality in ICU patients with OSA. These findings are only applicable to OSA patients who received lactate and albumin testing during ICU admission, and the results cannot be generalized to the entire population of ICU patients with OSA.
SN - 1198-2241
SN - 1916-7245
ER -