{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:55:49Z","timestamp":1777949749107,"version":"3.51.4"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"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>Elderly patients with severe acute pancreatitis (SAP) have high mortality, yet reliable early risk stratification tools remain limited. The lactate-to-albumin ratio (LAR) has emerged as a potential prognostic biomarker. This study aimed to evaluate the association between LAR and in-hospital mortality in elderly SAP patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively analyzed 313 patients aged \u226565\u202fyears with SAP admitted to the intensive care unit of a tertiary teaching hospital between 2016 and 2024. Demographic, clinical, and laboratory data were collected at admission. LAR was calculated from arterial lactate and serum albumin. Cox proportional hazards models were used to identify independent predictors of in-hospital mortality. Predictive performance of LAR was assessed using receiver operating characteristic (ROC) curves, Kaplan\u2013Meier survival analysis, and threshold effect modeling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety-four (30.0%) patients died during hospitalization. Non-survivors had significantly higher LAR values than survivors. Multivariable Cox regression confirmed LAR as an independent predictor of all-cause in-hospital mortality (HR 1.50, 95% CI 1.27\u20131.78;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The optimal LAR cutoff of 0.79 identified patients at high risk of death. ROC analysis showed that LAR (AUC 0.700) performed better than albumin (AUC 0.432) and was comparable to lactate (AUC 0.688) and SOFA score (AUC 0.732). Kaplan\u2013Meier curves demonstrated significantly reduced survival in the high-LAR group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>LAR is an independent predictor of all-cause in-hospital mortality in elderly SAP patients, offering a simple and effective biomarker for early risk stratification and clinical decision-making in this high-risk population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1754871","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:24:36Z","timestamp":1777868676000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical utility of the lactate-to-albumin ratio for predicting mortality in elderly severe acute pancreatitis"],"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":"Yingtong","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Gaoyou People\u2019s Hospital","place":["Gaoyou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lingli","family":"Wu","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":"Huihui","family":"Wang","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":"Yueli","family":"Chen","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":[[2026,5,4]]},"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, 2021","volume":"41","author":"Jaber","year":"2022","journal-title":"Anaesth Crit Care Pain Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1111\/den.13470","article-title":"Superiority of endoscopic interventions over minimally invasive surgery for infected necrotizing pancreatitis: meta-analysis of randomized trials","volume":"32","author":"Bang","year":"2020","journal-title":"Dig Endosc"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"2024","DOI":"10.1136\/gutjnl-2016-313595","article-title":"Acute pancreatitis: recent advances through randomised trials","volume":"66","author":"Van Dijk","year":"2017","journal-title":"Gut"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1016\/j.pan.2020.03.001","article-title":"Etiology and mortality in severe acute pancreatitis: a multicenter study in Japan","volume":"20","author":"Yasuda","year":"2020","journal-title":"Pancreatology"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1186\/s12876-025-04240-z","article-title":"Epidemiology of acute pancreatitis: the influence of age and gender in a regional population","volume":"25","author":"Akca","year":"2025","journal-title":"BMC Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"5268","DOI":"10.3748\/wjg.v29.i37.5268","article-title":"Acute pancreatitis: a review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence","volume":"29","author":"Hu","year":"2023","journal-title":"World J Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1186\/s12876-024-03308-6","article-title":"Construction and validation of a nomogram for predicting survival in elderly patients with severe acute pancreatitis: a retrospective study from a tertiary center","volume":"24","author":"Zhu","year":"2024","journal-title":"BMC Gastroenterol"},{"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":"330","DOI":"10.1097\/MOG.0000000000000456","article-title":"Management of acute pancreatitis in the first 72 hours","volume":"34","author":"James","year":"2018","journal-title":"Curr Opin Gastroenterol"},{"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 Anesth"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1233147","DOI":"10.3389\/fcvm.2023.1233147","article-title":"The lactate to albumin ratio linked to all-cause mortality in critically ill patients with septic myocardial injury","volume":"10","author":"Chen","year":"2023","journal-title":"Front Cardiovasc 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A retrospective, monocentric study","volume":"11","author":"Mihoc","year":"2021","journal-title":"Diagnostics (Basel)"},{"key":"ref30","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":"ref31","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 Ther"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1186\/s12876-020-01268-1","article-title":"Initially elevated arterial lactate as an independent predictor of poor outcomes in severe acute pancreatitis","volume":"20","author":"Shu","year":"2020","journal-title":"BMC Gastroenterol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1016\/j.mayocp.2013.06.012","article-title":"Etiology and therapeutic approach to elevated lactate levels","volume":"88","author":"Andersen","year":"2013","journal-title":"Mayo Clin Proc"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"2848","DOI":"10.1002\/hep.31836","article-title":"Albumin in advanced liver diseases: the good and bad of a drug!","volume":"74","author":"Jagdish","year":"2021","journal-title":"Hepatology"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1016\/j.ejim.2009.10.010","article-title":"Serum albumin as an outcome predictor in hospital emergency medical admissions","volume":"21","author":"Lyons","year":"2010","journal-title":"Eur J Intern Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"24158","DOI":"10.1038\/s41598-021-03449-8","article-title":"Hypoalbuminemia affects one third of acute pancreatitis patients and is independently associated with severity and mortality","volume":"11","author":"Ocskay","year":"2021","journal-title":"Sci Rep"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1186\/s12876-017-0615-8","article-title":"Serum albumin, a good indicator of persistent organ failure in acute pancreatitis","volume":"17","author":"Li","year":"2017","journal-title":"BMC Gastroenterol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1097\/SHK.0000000000001128","article-title":"Prognostic value of the lactate\/albumin ratio for predicting 28-day mortality in critically ILL Sepsis patients","volume":"50","author":"Shin","year":"2018","journal-title":"Shock"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1271391","DOI":"10.3389\/fneur.2023.1271391","article-title":"Association between lactate\/albumin ratio and 28-day all-cause mortality in ischemic stroke patients without reperfusion therapy: a retrospective analysis of the MIMIC-IV database","volume":"14","author":"Zhong","year":"2023","journal-title":"Front Neurol"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"e0255744","DOI":"10.1371\/journal.pone.0255744","article-title":"Association between lactate\/albumin ratio and all-cause mortality in patients with acute respiratory failure: a retrospective analysis","volume":"16","author":"Lu","year":"2021","journal-title":"PLoS One"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1754871\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:24:37Z","timestamp":1777868677000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1754871\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":40,"alternative-id":["10.3389\/fmed.2026.1754871"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1754871","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"1754871"}}