{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T19:08:27Z","timestamp":1781291307583,"version":"3.54.1"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"vor","delay-in-days":42,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    In recent years, the lactate-to-albumin ratio (LAR) has emerged as a novel prognostic marker in various critical illnesses, including sepsis, heart failure, and acute respiratory failure. However, its predictive value in patients with acute pancreatitis (AP)\u2014particularly those who develop acute pancreatitis\u2013associated acute kidney injury (AP-AKI)\u2014has not been fully evaluated. Given the high short-term all-cause mortality observed in AP-AKI patients, this study aims to examine the association between admission LAR levels and 30-day all-cause mortality in this population, with the goal of providing new evidence for clinical risk stratification and early intervention. We performed a retrospective cohort study of 877 critically ill patients with AP-AKI using the MIMIC-IV\/III database, and used the eICU-CRD database and a cohort of AP-AKI patients admitted to the Department of Critical Care Medicine, First Affiliated Hospital of Fujian Medical University (\n                    <jats:italic>FAHFMU<\/jats:italic>\n                    ) for external validation. Patients were stratified into four groups according to LAR quartiles. Confounding was assessed via linear or logistic regression with stepwise covariate removal, and univariable and multivariable Cox models were used to identify predictors of mortality. ROC analysis (AUC) evaluated LAR and other markers, establishing an optimal cut-off for Kaplan\u2013Meier survival curves (log-rank test). Restricted cubic spline (RCS) functions were used to explore the potential nonlinear relationship between LAR and 30-day mortality. Subgroup analyses were conducted across age, sex, comorbidities, and treatment categories. The study found that higher LAR levels were significantly associated with increased 30-day mortality in AP-AKI patients. After adjusting for potential confounders, LAR remained an independent predictor of mortality (HR 1.172, 95% CI 1.054\u20131.303,\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.05). ROC analysis showed an AUC of 0.695 for LAR, surpassing that of lactate alone (0.683) or albumin (0.589), and comparable to the SOFA score (0.684). Compared with the low LAR group, the high LAR group had a significantly higher mortality rate (\n                    <jats:italic>P<\/jats:italic>\n                    \u2009&lt;\u20090.001), and a nonlinear association between LAR and 30-day mortality was observed. LAR is an independent predictor of 30-day all-cause mortality in AP-AKI. Given its simplicity and accessibility yet modest discrimination, LAR may serve as a useful adjunct for early risk assessment, particularly when combined with established scores or used serially.\n                  <\/jats:p>","DOI":"10.1038\/s41598-026-42882-5","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T15:26:35Z","timestamp":1773242795000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association between lactate-to-albumin ratio and 30-day all-cause mortality in patients with acute pancreatitis-associated acute kidney injury"],"prefix":"10.1038","volume":"16","author":[{"given":"Mingjun","family":"Wei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yue","family":"Zhong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beilei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"issue":"1","key":"42882_CR1","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1053\/j.gastro.2021.09.043","volume":"162","author":"JP Iannuzzi","year":"2022","unstructured":"Iannuzzi, J. P. et al. Global incidence of acute pancreatitis is increasing over time: A systematic review and meta-analysis. Gastroenterology 162(1), 122\u2013134 (2022).","journal-title":"Gastroenterology"},{"issue":"7","key":"42882_CR2","doi-asserted-by":"publisher","first-page":"1106","DOI":"10.2215\/CJN.13191118","volume":"14","author":"TI Nassar","year":"2019","unstructured":"Nassar, T. I. & Qunibi, W. Y. AKI associated with acute pancreatitis. Clin. J. Am. Soc. Nephrol. 14(7), 1106\u20131115 (2019).","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"42882_CR3","doi-asserted-by":"publisher","first-page":"0","DOI":"10.1159\/000329239","volume-title":"Controversies in acute kidney injury","author":"M Matejovic","year":"2011","unstructured":"Matejovic, M. et al. Sepsis and acute kidney injury are bidirectional. In Controversies in acute kidney injury Vol. 174 (eds Ronco, C. et al.) 0 (S.Karger AG, 2011)."},{"key":"42882_CR4","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.sopen.2024.03.012","volume":"19","author":"A Metri","year":"2024","unstructured":"Metri, A., Bush, N. & Singh, V. K. Predicting the severity of acute pancreatitis: Current approaches and future directions. Surg. Open Sci. 19, 109\u2013117 (2024).","journal-title":"Surg. Open Sci."},{"issue":"1","key":"42882_CR5","doi-asserted-by":"publisher","DOI":"10.1186\/2110-5820-3-12","volume":"3","author":"J Bakker","year":"2013","unstructured":"Bakker, J., Nijsten, M. W. & Jansen, T. C. Clinical use of lactate monitoring in critically ill patients. Ann. Intensive Care 3(1), 12 (2013).","journal-title":"Ann. Intensive Care"},{"issue":"1","key":"42882_CR6","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-03449-8","volume":"11","author":"K Ocskay","year":"2021","unstructured":"Ocskay, K. et al. Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality. Sci. Rep. 11(1), 24158 (2021).","journal-title":"Sci. Rep."},{"issue":"1","key":"42882_CR7","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-022-21278-1","volume":"12","author":"T Ni","year":"2022","unstructured":"Ni, T. et al. Association between albumin or prealbumin levels at different stages and prognosis in severe acute pancreatitis: A 5-year retrospective study. Sci. Rep. 12(1), 16792 (2022).","journal-title":"Sci. Rep."},{"issue":"1","key":"42882_CR8","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-025-10838-1","volume":"25","author":"Y Wang","year":"2025","unstructured":"Wang, Y. & Yu, H. Association between lactate to albumin ratio and mortality among sepsis associated acute kidney injury patients. BMC Infect. Dis. 25(1), 414 (2025).","journal-title":"BMC Infect. Dis."},{"issue":"5","key":"42882_CR9","first-page":"1743","volume":"26","author":"SH Yoon","year":"2022","unstructured":"Yoon, S. H. et al. Using the lactate-to-albumin ratio to predict mortality in patients with sepsis or septic shock: a systematic review and meta-analysis. Eur. Rev. Med. Pharmacol. Sci. 26(5), 1743\u20131752 (2022).","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"42882_CR10","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2022.1076121","volume":"13","author":"Q Liu","year":"2022","unstructured":"Liu, Q. et al. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database. Front. Immunol. 13, 2022 (2022).","journal-title":"Front. Immunol."},{"issue":"1","key":"42882_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41597-022-01899-x","volume":"10","author":"AEW Johnson","year":"2023","unstructured":"Johnson, A. E. W. et al. MIMIC-IV, a freely accessible electronic health record dataset. Sci. Data 10(1), 1 (2023).","journal-title":"Sci. Data"},{"key":"42882_CR12","doi-asserted-by":"publisher","DOI":"10.1038\/sdata.2016.35","volume":"3","author":"AEW Johnson","year":"2016","unstructured":"Johnson, A. E. W. et al. MIMIC-III, a freely accessible critical care database. Sci. Data 3, 160035 (2016).","journal-title":"Sci. Data"},{"issue":"4","key":"42882_CR13","doi-asserted-by":"publisher","first-page":"c179","DOI":"10.1159\/000339789","volume":"120","author":"A Khwaja","year":"2012","unstructured":"Khwaja, A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin. Pract. 120(4), c179\u2013c184 (2012).","journal-title":"Nephron Clin. Pract."},{"issue":"1","key":"42882_CR14","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1002\/ueg2.12743","volume":"13","author":"A Beij","year":"2025","unstructured":"Beij, A. et al. Acute pancreatitis: An update of evidence-based management and recent trends in treatment strategies. United Eur. Gastroenterol. J. 13(1), 97\u2013106 (2025).","journal-title":"United Eur. Gastroenterol. J."},{"key":"42882_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ejim.2024.10.030","volume":"133","author":"K Hamesch","year":"2025","unstructured":"Hamesch, K. et al. Practical management of severe acute pancreatitis. Eur. J. Intern. Med. 133, 1\u201313 (2025).","journal-title":"Eur. J. Intern. Med."},{"key":"42882_CR16","doi-asserted-by":"publisher","first-page":"10511","DOI":"10.2147\/IJGM.S339767","volume":"14","author":"X Zhu","year":"2021","unstructured":"Zhu, X. et al. The lactate\/albumin ratio predicts mortality in critically ill patients with acute kidney injury: An observational multicenter study on the eICU database. Int. J. General Med. 14, 10511\u201310525 (2021).","journal-title":"Int. J. 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Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements. The part of the study involving data from the First Affiliated Hospital of Fujian Medical University has been approved by the Ethics Committee of the First Affiliated Hospital of Fujian Medical University. The requirement for informed consent was waived by the ethics committee due to the retrospective\/anonymized nature of the study. All procedures were conducted in accordance with relevant guidelines and regulations, including the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"13127"}}