Objective To evaluate the association between the lactate-to-albumin ratio (LAR) and the development of post-contrast acute kidney injury (PC-AKI) in patients undergoing intravenous contrast-enhanced computed tomography (CT) in the emergency department (ED), and to compare its discriminative performance with other biomarker ratios.
Methods This retrospective observational study included adult patients who underwent contrastenhanced CT in a tertiary ED between January 2022 and January 2025. Patients with available baseline and 48–72-hour post-contrast serum creatinine measurements were analyzed. LAR, blood urea nitrogen–to–albumin ratio (BAR), C-reactive protein–to–albumin ratio (CAR), and neutrophil-tolymphocyte ratio (NLR) were calculated using laboratory values obtained at ED presentation. Logistic regression analyses were performed, and receiver operating characteristic curves were constructed.
Results A total of 695 patients were included, and PC-AKI occurred in 43 (6.2%). Patients with PCAKI were older and had higher hemoglobin, creatinine, blood urea nitrogen, C-reactive protein, and lactate levels, as well as lower albumin and estimated glomerular filtration rate values (all p<0.05). LAR, BAR, CAR, and NLR differed between groups. In multivariable analysis, LAR (OR=3.898; 95% CI: 2.799–5.430; p<0.001), BAR (OR=1.635; 95% CI: 1.171–2.283; p=0.004), and NLR (OR=1.820; 95% CI: 1.359–2.438; p<0.001) were associated with PC-AKI. LAR showed an area under the curve of 0.854, with a sensitivity of 88.4% and a negative predictive value of 98.9% at a cut-off of >0.51.
Conclusion LAR measured at ED presentation was associated with the development of PC-AKI following contrast-enhanced CT and demonstrated higher discriminative performance compared with other evaluated ratios. These findings suggest that LAR may be useful for risk stratification in this clinical context.
Objective Sepsis is a leading cause of acute kidney injury (sepsis-associated acute kidney injury, SA-AKI) and is associated with multiorgan failure, cardiovascular events, and increased mortality. While research has generally focused on critically ill patients in intensive care units (ICUs), most sepsis cases are managed outside the ICU. This study investigated renal dysfunction as an early risk marker in patients presenting to the emergency department (ED) with severe infection and at risk for early sepsis. Methods This post hoc analysis of patients presenting to the ED used data from the Acutelines cohort (2020–2023). Kaplan-Meier curves and univariable and multivariable Cox regression analyses were performed to assess the association between AKI and all-cause mortality, as well as in-hospital mortality and cardiovascular death, adjusting for potential confounders. Results In total, 2,045 patients presented with sepsis at the ED, of whom 246 (12%) had AKI. The overall mortality rate was 25% over a median follow-up of 346 days. AKI was associated with higher all-cause mortality (38% vs. 26%; P<0.001). After adjustment for sex, age, comorbidities, and sepsis severity, AKI remained independently associated with all-cause mortality (hazard ratio [HR], 1.44; 95% confidence interval [CI], 1.14–1.82; P=0.003), in-hospital mortality (HR, 1.65; 95% CI, 1.16–2.34; P=0.006), and cardiovascular death (HR, 2.50; 95% CI, 1.39–4.48; P=0.001). Similar outcomes were observed in a subanalysis excluding ICU patients. Conclusion SA-AKI at ED presentation is independently associated with increased all-cause, in-hospital, and cardiovascular mortality. These findings underscore the need for earlier recognition across care settings and the implementation of structured follow-up to improve patient outcomes.
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Machine Learning-Based Subtype Classification of Sepsis-Associated Acute Kidney Injury and Differential Responses to Renal Replacement Therapy Hongkun Zhang, Shengzhi Wang, Tao Zhang, Baisen Wang, Ziqi Jiang, Zhenqi Guo Journal of Intensive Care Medicine.2026;[Epub] CrossRef
Objective We aimed to investigate uric acid and albumin ratio (UA/A) as a marker of short-term mortality in acute kidney injury (AKI). Both uric acid and albumin are strongly correlated with the development and mortality of AKI.
Methods The patients hospitalized from May 2019 to September 2019 for AKI were included in this study. The diagnostic odds ratio (DOR), Youden index (J), and the area under a receiver operating characteristic curve (AUROC) determined a cut-off UA/A ratio for mortality. Cox-regression analysis was performed to identify UA/A as a prognostic marker of the 30-day mortality rate.
Results A total of 171 patients with an average age of 69.20±13.0 (45.6% women) were included in the study. The average UA/A ratio was 3.3±1.5 mg/g and 2.5±1.0 mg/g in the non-survivor and survivor groups, respectively (P=0.001). The best cut-off UA/A ratio associated with mortality was determined as 2.4 mg/g with a specificity of 52% and a sensitivity of 77% (DOR, 3.6; J, 28.8; AUROC, 0.644). Thirty-day cumulative survival rates of the low and high UA/A ratio groups were 85.9±4.0% and 63.7±5.0%, respectively. The estimated survival times of the low and high UA/A ratio groups were 27.7 days (95% confidence interval [CI], 26.2–29.3) and 23.9 days (95% Cl, 22.0–25.9), respectively.
Conclusion We found a direct correlation between 30-day mortality and UA/A ratio at initial presentation in AKI patients regardless of age, comorbidities, and clinical and laboratory findings, including albuminuria.
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