{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:25:03Z","timestamp":1787833503848,"version":"build-2784847793"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: The lactate\/albumin ratio (LAR) integrates tissue hypoperfusion and nutritional reserve into a single dimensionless index. As a late-course measurement (last available value before the primary outcome), it may reflect terminal metabolic deterioration rather than early prognostic signal. We examined the association of the final LAR with in-hospital mortality after adjustment for validated severity scores (APACHE II, SOFA) in critically ill patients receiving CRRT, and evaluated its incremental value beyond lactate alone. Methods: A single-centre retrospective observational study was conducted, including 110 adult patients treated with CRRT\/CVVHDF at Konya City Hospital (January 2024\u2013January 2026). Multivariable logistic regression was performed across four hierarchically adjusted models. APACHE II was designated the primary adjustment covariate. ROC analyses compared the final LAR with final lactate and albumin alone. Results: In-hospital mortality was 70.9% (78\/110); complete paired final lactate and albumin values were available for 109\/110 patients (78 non-survivors, 31 survivors). After APACHE II adjustment, each 0.1-unit increase in the late-course LAR remained significantly associated with in-hospital mortality (OR 1.70; 95% CI 1.16\u20132.49; p = 0.007), a finding replicated in the ICU-stay sensitivity cohort (n = 100, 73 events; OR 1.63; 95% CI 1.09\u20132.42; p = 0.016). The LAR trajectory (\u0394LAR; AUC 0.725) was significantly greater in non-survivors (+0.104 vs. \u22120.060; p &lt; 0.001); however, \u0394LAR did not significantly outperform the lactate trajectory alone (\u0394lactate; AUC 0.706; p = 0.212), and lost statistical significance after severity-score adjustment. Furthermore, the association was attenuated and non-significant after SOFA adjustment (OR 1.35; p = 0.077), and the final LAR did not provide statistically significant discriminative advantage over lactate alone (AUC 0.768 vs. 0.761; LRT p = 0.435). Conclusions: The late-course LAR remained significantly associated with mortality after APACHE II adjustment. Three qualifications temper this finding: the association was attenuated after SOFA adjustment, the final LAR did not outperform lactate alone, and the measurement design is susceptible to reverse causality. The LAR trajectory (\u0394LAR; AUC 0.725) showed comparable discrimination to the final LAR but did not significantly outperform the lactate trajectory alone (\u0394lactate; AUC 0.706; p = 0.212) and lost statistical significance after severity-score adjustment, so it should likewise be regarded as hypothesis-generating rather than confirmatory; prospective evaluation with time-stamped serial measurements and landmark analyses in multi-centre CRRT cohorts is warranted.<\/jats:p>","DOI":"10.3390\/jcm15176625","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T12:03:43Z","timestamp":1787832223000},"page":"6625","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Late-Course Lactate\/Albumin Ratio and In-Hospital Mortality in CRRT-Treated Critically Ill Patients: A Retrospective Severity-Adjusted Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9956-1788","authenticated-orcid":false,"given":"Hasan","family":"\u015eenay","sequence":"first","affiliation":[{"name":"Department of Intensive Care, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8173-7414","authenticated-orcid":false,"given":"Mehmet K\u00fcr\u015fad","family":"Orhan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5709-6504","authenticated-orcid":false,"given":"Mahmut Sami","family":"Tutar","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munise","family":"Y\u0131ld\u0131z","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ece \u00dcn\u00fcvar","family":"\u015eenay","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Konya Numune Hospital, 42060 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-0652-3624","authenticated-orcid":false,"given":"Muhammed Halit","family":"Sat\u0131c\u0131","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet","family":"Erarkada\u015f","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5097-9291","authenticated-orcid":false,"given":"Betul","family":"Kozanhan","sequence":"additional","affiliation":[{"name":"Department of Anaesthesiology and Reanimation, Konya City Hospital, 42020 Konya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s00134-015-3934-7","article-title":"Epidemiology of acute kidney injury in critically ill patients: The multinational AKI-EPI study","volume":"41","author":"Hoste","year":"2015","journal-title":"Intensive Care Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s13613-017-0260-y","article-title":"Acute kidney injury in the ICU: From injury to recovery","volume":"7","author":"Bellomo","year":"2017","journal-title":"Ann. Intensive Care"},{"key":"ref_3","doi-asserted-by":"crossref","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":"ref_4","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/01.SLA.0000055547.93484.87","article-title":"Hypoalbuminemia in acute illness: Is there a rationale for intervention?","volume":"237","author":"Vincent","year":"2003","journal-title":"Ann. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Bou Chebl, R., Jamali, S., Sabra, M., Safa, R., Berbari, I., Shami, A., Makki, M., Tamim, H., and Dagher, G.A. (2020). Lactate\/albumin ratio as a predictor of in-hospital mortality in septic patients presenting to the emergency department. Front. Med., 7.","DOI":"10.3389\/fmed.2020.550182"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Wang, R., He, M., Qu, F., Zhang, J., and Xu, J. (2022). Lactate albumin ratio is associated with mortality in patients with moderate to severe traumatic brain injury. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.662385"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2088","DOI":"10.1016\/j.ajem.2020.06.067","article-title":"Lactate\/albumin ratio: An early prognostic marker in critically ill patients","volume":"38","author":"Gharipour","year":"2020","journal-title":"Am. J. Emerg. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2374451","DOI":"10.1080\/0886022X.2024.2374451","article-title":"Association between lactate\/albumin ratio and prognosis in critically ill patients with AKI undergoing CRRT","volume":"46","author":"Liu","year":"2024","journal-title":"Ren. Fail."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"He, S., Wang, Y., Wei, S., and Yang, S. (2025). Correlation between lactate\/albumin ratio and 28-day mortality in sepsis-associated AKI patients. Front. Med., 12.","DOI":"10.3389\/fmed.2025.1546112"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1093\/ije\/15.3.413","article-title":"Identifiability, exchangeability, and epidemiological confounding","volume":"15","author":"Greenland","year":"1986","journal-title":"Int. J. Epidemiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/BF01709751","article-title":"The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction\/failure","volume":"22","author":"Vincent","year":"1996","journal-title":"Intensive Care Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/EDE.0b013e3181c30fb2","article-title":"Assessing the performance of prediction models","volume":"21","author":"Steyerberg","year":"2010","journal-title":"Epidemiology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1186\/s13054-016-1403-5","article-title":"The value of blood lactate kinetics in critically ill patients: A systematic review","volume":"20","author":"Vincent","year":"2016","journal-title":"Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","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":"ref_15","first-page":"413","article-title":"Landmark analysis at the 25-year landmark point","volume":"8","author":"Dafni","year":"2011","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"R25","DOI":"10.1186\/cc8888","article-title":"Relative hyperlactatemia and hospital mortality in critically ill patients","volume":"14","author":"Nichol","year":"2010","journal-title":"Crit. Care"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1007\/s00134-021-06506-y","article-title":"Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock 2021","volume":"47","author":"Evans","year":"2021","journal-title":"Intensive Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"10511","DOI":"10.2147\/IJGM.S339767","article-title":"The Lactate\/Albumin Ratio Predicts Mortality in Critically Ill Patients with Acute Kidney Injury: An Observational Multicenter Study on the eICU Database","volume":"14","author":"Zhu","year":"2021","journal-title":"Int. J. Gen. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"10087","DOI":"10.1038\/s41598-025-94753-0","article-title":"Association between lactate-albumin ratio and 28-day mortality in patients with sepsis-associated acute kidney injury: A retrospective cohort study","volume":"15","author":"Tang","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Wang, Y., and Yu, H. (2025). Association between lactate to albumin ratio and mortality among sepsis associated acute kidney injury patients. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10838-1"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1159\/000534970","article-title":"The impact of C-reactive protein-to-albumin ratio on mortality in patients with acute kidney injury requiring continuous renal replacement therapy: A multicenter retrospective study","volume":"148","author":"Jeon","year":"2024","journal-title":"Nephron"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kim, S.G., Lee, J., Yun, D., Kang, M.W., Kim, Y.C., Kim, D.K., Oh, K.-H., Joo, K.W., Kim, Y.S., and Han, S.S. (2023). Hyperlactatemia is a predictor of mortality in patients undergoing continuous renal replacement therapy for acute kidney injury. BMC Nephrol., 24.","DOI":"10.1186\/s12882-023-03063-y"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1244","DOI":"10.1007\/s001340051052","article-title":"The use of different buffers during continuous hemofiltration in critically ill patients with acute renal failure","volume":"25","author":"Heering","year":"1999","journal-title":"Intensive Care Med."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lv, J., Wang, H., Sun, B., Gao, Y., Zhang, Z., and Pei, H. (2021). Serum albumin before CRRT was associated with the 28- and 90-day mortality of critically ill patients with AKI treated with CRRT. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.717918"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1186\/s13613-015-0095-3","article-title":"Prevention and treatment of sepsis-related acute kidney injury: An update","volume":"5","author":"Jacobs","year":"2015","journal-title":"Ann. 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