Associations of lactate-to-hematocrit ratio with short- and long-term prognoses in critically ill patients with cirrhosis and sepsis: a retrospective cohort study

Abstract

Background: The lactate-to-hematocrit ratio (LHR) is strongly associated with the prognosis of patients critically ill with various diseases. However, the relationship between LHR and the prognosis of critically ill patients with cirrhosis and sepsis has not been explored. Therefore, this study examined the association between the LHR and short- and long-term prognoses in this special group of patients. Methods: Hospitalization data of patients with cirrhosis and sepsis in an intensive care unit between 2008 and 2022 were retrospectively analyzed. The LHR was calculated from arterial blood lactate and hematocrit levels obtained during the first measurement within 24 h of admission. The threshold for optimal LHR was determined using standard statistical tools in R. The risks of death were compared between patients with LHR values above and below this threshold. Multivariate Cox proportional hazards regression models were used to examine the association between LHR and the short- and long-term mortality risks in this group of patients. The potential dose-response relationship between LHR and mortality were investigated. Additionally, the predictive ability, sensitivity, and specificity of LHR for the risk of all-cause mortality were evaluated. Finally, subgroup analyses were performed to assess the relationship between LHR and prognosis in different populations. Results: Among the 1881 patients included in this study, the threshold LHR was 0.12. Kaplan–Meier analysis showed that patients with higher LHR had significantly higher risks of intensive care unit (ICU); in-hospital; and 14-, 28-, and 90-day mortality (all log-rank P < 0.001). The multivariate Cox proportional hazards models suggested an independent association between high LHR and 14-, 28-, and 90-day all-cause mortalities. RCS analyses showed a nonlinear association between LHR and short- and long-term all-cause mortality in patients with cirrhosis and sepsis. ROC curve analyses showed that LHR had a better predictive ability for prognosis in patients with cirrhosis combined with sepsis than other indicators. Subgroup analysis showed no significant interaction between LHR and most of the subgroups. Conclusion: High LHR values were strongly associated with poor short- and long-term prognoses in critically ill patients with cirrhosis and sepsis.