Objective:

To evaluate the predictive value of the lactate-to-albumin ratio (LAR) for 28-day mortality in ICU patients with acute pulmonary embolism (APE) and to explore its potential role in the simplified Pulmonary Embolism Severity Index (sPESI) score.

Approach:

Key Findings:

• LAR showed a linear relationship with 28-day mortality.
• AUC for LAR predicting mortality was 0.610 (derivation), 0.710 (first validation), and 0.647 (second validation).
• The LAR-sPESI score improved predictive performance modestly: AUC = 0.650 (derivation), 0.733 (first validation), 0.701 (second validation).
• DCA indicated potential clinical utility of LAR within certain thresholds across cohorts.
• LAR had moderate discriminative ability for norepinephrine use but limited predictive performance for thrombolysis and mechanical ventilation.

Interpretation:

LAR serves as a predictor of 28-day mortality in ICU patients with APE, with the LAR-sPESI score showing modest improvements in predictive performance.

Limitations:

• The study is retrospective and may have inherent biases.
• The predictive performance for certain clinical interventions was limited.

Conclusion:

LAR may enhance risk stratification in ICU patients with APE, though the LAR-sPESI score showed only modest numerical gains in predictive performance.

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