Abstract
BACKGROUND: Patients with advanced cirrhosis are at an elevated risk of mortality, underscoring the need for reliable prognostic markers. This study aims to evaluate the association between the lactate-to-glucose ratio (LGR) and all-cause mortality in critically ill patients with cirrhosis, providing insights into potential predictive indicators in this high-risk population. METHODS: This study investigated the association between the LGR and mortality risk in critically ill cirrhotic patients using data from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v3.1) and the eICU Collaborative Research Database (eICU-CRD). First, variable importance was assessed using the Boruta feature selection algorithm. Multivariable Cox regression was applied to examine the relationship between LGR and short-term mortality in critically ill cirrhotic patients, followed by risk stratification using X-tile software. Survival outcomes were evaluated via Kaplan-Meier (KM) analysis, while diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. Additionally, restricted cubic spline (RCS) regression was utilized to explore potential non-linear associations, and subgroup interaction analyses were performed. RESULT: This retrospective study analyzed 3,366 patients from MIMIC and 478 from eICU-CRD, with ICU mortality rates of 27.75% and 21.96%, respectively. Using 30-day mortality data from MIMIC, we applied the Boruta Based Feature Importance Analysis to confirm LGR’s prognostic value and established an optimal cutoff of 0.68 via X-tile (high-risk: LGR ≥ 0.68; low-risk: LGR < 0.68). Multivariate Cox regression revealed LGR as an independent mortality predictor in cirrhotic patients (P < 0.001), corroborated by K-M analysis showing reduced high-risk survival (P < 0.001). ROC curves indicated moderate short-term mortality prediction, while restricted cubic spline analysis indicated a positive correlation between LGR and mortality. subgroup analyses revealed no significant interaction effects. CONCLUSION: LGR is associated with short-term mortality in ill patients with cirrhosis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12876-025-04359-z.