Abstract
BACKGROUND: Severe acute pancreatitis (SAP) carries a mortality rate of up to 30%. This study evaluated the association between the lactate dehydrogenase-to-albumin ratio (LAR) and in-hospital mortality in patients with predicted SAP. METHODS: A total of 4605 patients (APACHE II ≥8) admitted to the First Affiliated Hospital of Nanchang University from 2005 to 2023 were retrospectively analyzed. Cox regression, restricted cubic splines, Kaplan-Meier curves, and Log rank tests assessed the association between LAR and mortality. Receiver operating characteristic (ROC) and time-dependent ROC curves evaluated predictive performance. Subgroup and sensitivity analyses confirmed robustness. RESULTS: Elevated LAR independently predicted in-hospital mortality (adjusted HR per SD: 1.14; 95% CI: 1.09-1.19; P < 0.001). Kaplan-Meier curves showed significantly lower survival in high-LAR groups (P < 0.05). LAR outperformed LDH, albumin, SIRS, and APACHE II (AUC = 0.847; 95% CI: 0.826-0.869). A non-linear association with a threshold at LAR = 20.58 was identified. Predictive value remained stable across etiologies and both short-term (≤14 days) and long-term (30-90 days) mortality. Stronger associations were seen in younger, male, hypertriglyceridemic patients and those without persistent multiple organ failure. CONCLUSION: Higher LAR was associated with greater in-hospital mortality among patients with predicted severe acute pancreatitis; LAR may serve as a simple, low-cost adjunct for early risk assessment.