LAR is a meaningful indicator for early mortality risk in AMI-CS, and a nomogram incorporating LAR with conventional clinical indicators achieved an AUC of 0.928, outperforming existing risk scores including CardShock, APACHE II, and blood lactate alone.
LAR was significantly higher in patients who died in-hospital compared to survivors among AMI-CS patients.
LAR was an independent predictor of in-hospital mortality with an optimal cutoff value of 1.997.
Five independent predictors of in-hospital mortality were identified: LAR, cold and clammy skin, aspartate aminotransferase, C-reactive protein, and left ventricular ejection fraction less than 40%.
The nomogram-based prediction model achieved an AUC of 0.928, outperforming existing risk scores.
In-hospital mortality occurred in 23 of 129 enrolled AMI-CS patients, representing a mortality rate of approximately 17.8% in this cohort.
This research suggests that a simple ratio calculated from two commonly measured blood values — lactate (a marker of poor oxygen delivery) and albumin (a protein that reflects nutritional and inflammatory status) — can help predict which patients with heart attack-related cardiogenic shock are at highest risk of dying in the hospital. Among 129 patients admitted with this serious condition, those who ultimately died had a lactate-to-albumin ratio (LAR) nearly five times higher than those who survived. A LAR value above approximately 2.0 identified high-risk patients with reasonable accuracy, and performed better than blood lactate measured alone. The researchers also built a more comprehensive prediction tool called a nomogram, which combines LAR with four other clinical findings: cold and clammy skin, elevated liver enzyme (AST), elevated inflammation marker (CRP), and reduced heart pumping function (ejection fraction below 40%). This combined model was highly accurate (AUC of 0.928) and outperformed established scoring systems including CardShock and APACHE II. The model also showed good calibration, meaning its predicted probabilities closely matched actual outcomes. This research suggests that LAR could be a practical, low-cost addition to bedside risk assessment in critically ill cardiac patients, since lactate and albumin are routinely measured in emergency and intensive care settings. The nomogram may help clinicians make faster decisions about treatment intensity for patients with heart attack-related cardiogenic shock. However, as a single-center study with a relatively small sample, these findings would benefit from validation in larger, multi-center populations before widespread clinical adoption.
Angdembe R, Wu Y, Ke Q, Jin Y, Yao L. (2026). Prognostic value of the lactate-albumin ratio and development of a nomogram-based prediction model in patients with acute myocardial infarction-associated cardiogenic shock.. Medicine. https://doi.org/10.1097/MD.0000000000050436