Elevated Lactate-to-Albumin Ratio: A Critical Predictor of Adverse Outcomes in Coronary Syndrome

Abstract

Aim: Acute coronary syndrome (ACS) encompasses a range of life-threatening conditions, including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), in which early mortality continues to pose a significant challenge. Prompt recognition of high-risk patients is crucial to enable timely interventions that may enhance survival outcomes. Current prognostic tools may not be sufficient for early risk assessment. The lactate-albumin ratio (LAR) is a promising, cost-effective marker that could help predict early mortality in ACS patients, enabling better risk stratification and improving clinical outcome
Material and Methods: This retrospective, single-center study included 200 hospitalized patients, comprising 100 with STEMI and 100 with NSTEMI. Laboratory analyses were performed on blood samples and arterial blood gas measurements obtained at the time of admission. In-hospital mortality and arrhythmia rates were compared between the groups based on the lactate-albumin ratio.
Results: LAR levels were compared based on mortality status. The median (IQR) LAR for deceased patients was 1.13 (0.53–1.30), significantly higher than that of surviving patients [median (IQR) LAR: 0.41 (0.32–0.54), p < 0.001]. At a cut-off value of 0.89, LAR had 73.3% sensitivity and 97.3% specificity for predicting mortality. Logistic regression analysis confirmed LAR as a strong predictor of mortality (Nagelkerke R² = 45.5%, B = 5.78, OR = 323, 95% CI: 35.45–2956, p < 0.001).
Conclusion: In acute coronary syndrome, the lactate–albumin ratio may serve as a practical biomarker for early risk stratification and identification of high-risk patients rather than as a diagnostic tool.

Keywords

• Lactate
• albumin
• acute coronary syndrome

References

1. 1. Woodruff RC, Tong X, Khan SS, Shah NS, Jackson SL, Loustalot F, et al. Trends in cardiovascular disease mortality rates and excess deaths, 2010–2022. Am J Prev Med. 2024;66:582–9. doi:10.1016/j.amepre.2023.11.009.
2. 2. Global Cardiovascular Risk Consortium; Magnussen C, Ojeda FM, Leong DP, Alegre-Diaz J, Amouyel P, et al. Global effect of modifiable risk factors on cardiovascular disease and mortality. N Engl J Med. 2023;389(14):1273-85. doi:10.1056/NEJMoa2206916.
3. 3. Wu Y, Ma W, Liu W, Zhang S. Lactate: a pearl dropped in the ocean-an overlooked signal molecule in physiology and pathology. Cell Biol Int. 2023;47(2):295-307. doi:10.1002/cbin.11975.
4. 4. Bou CR, Jamali S, Sabra M, Safa R, Berbari I, Shami A, et al. Lactate/albumin ratio as a predictor of in-hospital mortality in septic patients presenting to the emergency department. Front Med (Lausanne). 2020;7:550182. doi:10.3389/fmed.2020.550182.
5. 5. Lu Y, Guo H, Chen X, Zhang Q. Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: a retrospective analysis. PloS One. 2021;16:e0255744. doi:10.1371/journal.pone.0255744.
6. 6. Wardi G, Brice J, Correia M, Liu D, Self M, Tainter C. Demystifying lactate in the emergency department. Ann Emerg Med. 2020;75:287-98. doi:10.1016/j.annemergmed.2019.06.027.
7. 7. Ronit A, Kirkegaard-Klitbo DM, Dohlmann TL, Lundgren J, Sabin CA, Phillips AN, et al. Plasma albumin and incident cardiovascular disease: results from the CGPS and an updated meta-analysis. Arterioscler Thromb Vasc Biol. 2020;40:473-82. doi:10.1161/ATVBAHA.119.313681.
8. 8. Vermeulen RP, Hoekstra M, Nijsten MW, van der Horst IC, van Pelt LJ, Jessurun GA, et al. Clinical correlates of arterial lactate levels in patients with ST-segment elevation myocardial infarction at admission: a descriptive study. Crit Care. 2010;14(5):R164. doi:10.1186/cc9253.

9. 9. Lazzeri C, Valente S, Chiostri M, Gensini GF. Clinical significance of lactate in acute cardiac patients. World J Cardiol. 2015;7(8):483-9. doi:10.4330/wjc.v7.i8.483.
10. 10. Liao LZ, Zhang SZ, Li WD, Liu Y, Li JP, Zhuang X, et al. Serum albumin and atrial fibrillation: insights from epidemiological and mendelian randomization studies. Eur J Epidemiol 2020;35:113-22. doi:10.1007/s10654-019-00583-6.
11. 11. Nagai T, Yoshikawa T, Saito Y, Takeishi Y, Yamamoto K, Ogawa H, et al. Clinical characteristics, management, and outcomes of Japanese patients hospitalized for heart failure with preserved ejection fraction―a report from the Japanese heart failure syndrome with preserved ejection fraction (JASPER) Registry. Cir J. 2018;82(6):1534-45. doi:10.1253/circj.CJ-18-0073.
12. 12. Cheng CW, Lee CW, Chien SC, Yeh HI, Chen CY. Serum albumin was associated with a long term cardiovascular mortality among elderly patients with stable coronary artery disease. Acta Cardiol Sin. 2024;40:87–96. doi:10.6515/ACS.202401_40(1).20230825A.
13. 13. Gharipour A, Razavi R, Gharipour M, Mukasa M. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am J Emerg Med. 2020;38(10):2088-95. doi:10.1016/j.ajem.2020.06.067.
14. 14. Yang Chen, Weiyan Lai, Ke Yang, Wu B, Xie D, Peng C. Association between lactate/albumin ratio and prognosis in patients with acute myocardial infarction. Eur J Clin Invest. 2024;54(1):e14094. doi:10.1111/eci.14094.
15. 15. Kong T, Chun SP, Lee HS, Kim S, Lee J, Hwang SO, et al. The prognostic usefulness of the lactate/albumin ratio for predicting clinical outcomes in out-of-hospital cardiac arrest: a prospective, multicenter observational study (koCARC) study. Shock. 2020;53: 442-51. doi:10.1097/SHK.0000000000001405.