Clinical utility of the lactate-to-albumin ratio for predicting mortality in elderly severe acute pancreatitis

Background Elderly patients with severe acute pancreatitis (SAP) have high mortality, yet reliable early risk stratification tools remain limited. The lactate-to-albumin ratio (LAR) has emerged as a potential prognostic biomarker. This study aimed to evaluate the association between LAR and in-hospital mortality in elderly SAP patients. Methods We retrospectively analyzed 313 patients aged ≥65 years with SAP admitted to the intensive care unit of a tertiary teaching hospital between 2016 and 2024. Demographic, clinical, and laboratory data were collected at admission. LAR was calculated from arterial lactate and serum albumin. Cox proportional hazards models were used to identify independent predictors of in-hospital mortality. Predictive performance of LAR was assessed using receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and threshold effect modeling. Results Ninety-four (30.0%) patients died during hospitalization. Non-survivors had significantly higher LAR values than survivors. Multivariable Cox regression confirmed LAR as an independent predictor of all-cause in-hospital mortality (HR 1.50, 95% CI 1.27–1.78; p 0.001). The optimal LAR cutoff of 0.79 identified patients at high risk of death. ROC analysis showed that LAR (AUC 0.700) performed better than albumin (AUC 0.432) and was comparable to lactate (AUC 0.688) and SOFA score (AUC 0.732). Kaplan–Meier curves demonstrated significantly reduced survival in the high-LAR group. Conclusion LAR is an independent predictor of all-cause in-hospital mortality in elderly SAP patients, offering a simple and effective biomarker for early risk stratification and clinical decision-making in this high-risk population.