{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T06:11:52Z","timestamp":1777961512256,"version":"3.51.4"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Acute 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This 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\u202fh 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In-hospital mortality was 23.6% (83\/351). Non-survivors had significantly higher LAR levels than survivors (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). After adjusting for confounders, LAR remained independently associated with mortality (OR\u202f=\u202f1.32, 95% CI: 1.04\u20131.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.024). ROC analysis showed that LAR outperformed albumin and achieved accuracy comparable to lactate and SOFA. High LAR (\u22651.32) was associated with lower 28-day survival (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). A threshold effect was identified at LAR\u202f=\u202f1.78.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAR 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1734599","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T05:32:34Z","timestamp":1777959154000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Early prognostic value of the lactate-to-albumin ratio in severe acute pancreatitis with acute respiratory distress syndrome"],"prefix":"10.3389","volume":"13","author":[{"given":"Qingcheng","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mingfeng","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dingyu","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Northern Jiangsu People\u2019s Hospital Affiliated to Yangzhou University","place":["Yangzhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"101060","DOI":"10.1016\/j.accpm.2022.101060","article-title":"Guidelines for the management of patients with severe acute pancreatitis, 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assessment","volume":"11","author":"Capurso","year":"2023","journal-title":"United Eur Gastroenterol J"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1076121","DOI":"10.3389\/fimmu.2022.1076121","article-title":"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","volume":"13","author":"Liu","year":"2022","journal-title":"Front Immunol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"4561","DOI":"10.1242\/jeb.01961","article-title":"Lactate--a signal coordinating cell and systemic function","volume":"208","author":"Philp","year":"2005","journal-title":"J Exp Biol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2223","DOI":"10.1007\/s10620-024-08419-4","article-title":"Serum lactate is an indicator for short-term and long-term mortality in patients with acute pancreatitis","volume":"69","author":"Zeng","year":"2024","journal-title":"Dig Dis Sci"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1007\/s00134-015-4127-0","article-title":"Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients","volume":"42","author":"Haas","year":"2016","journal-title":"Intensive Care Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1186\/s12951-021-00896-3","article-title":"Protein nanoparticles in drug delivery: animal protein, plant proteins and protein cages, albumin nanoparticles","volume":"19","author":"Kianfar","year":"2021","journal-title":"J Nanobiotechnol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"111632","DOI":"10.1016\/j.jclinane.2024.111632","article-title":"Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome","volume":"99","author":"Wang","year":"2024","journal-title":"J Clin 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pancreatitis","volume":"65","author":"Li","year":"2020","journal-title":"Dig Dis Sci"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"e9654","DOI":"10.1097\/MD.0000000000009654","article-title":"Serial evaluation of the SOFA score is reliable for predicting mortality in acute severe pancreatitis","volume":"97","author":"Tee","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"e39515","DOI":"10.7759\/cureus.39515","article-title":"Comparing prognostic scores and inflammatory markers in predicting the severity and mortality of acute pancreatitis","volume":"15","author":"Jain","year":"2023","journal-title":"Cureus"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1038\/s41392-022-01151-3","article-title":"Lactate metabolism in human health and disease","volume":"7","author":"Li","year":"2022","journal-title":"Signal Transduct Target 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