Division
East Florida
Hospital
HCA Florida Westside Hospital
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
myocardial infarction, MI, heart failure
Disciplines
Cardiovascular Diseases | Internal Medicine
Abstract
BACKGROUND Robust biomarkers that capture the combined effects of inflammation and tissue hypoperfusion, are needed to refine post–acute myocardial infarction (AMI) risk stratification—especially in the large subset that develops congestive heart failure (CHF). Two emerging candidates are the lactate/albumin ratio (LAR) and the red-cell-distribution-width/albumin ratio (RAR). Separate studies have linked each ratio to short- and long-term mortality in critical illness, AMI, and heart failure, yet no work has directly compared their performance together. We addressed this evidence gap in a large, multi-hospital dataset.
METHODS We performed a retrospective analysis of 8 115 encounters drawn from the HCA Healthcare database (2016-2024). Adults with confirmed AMI complicated by CHF and documented lactate, RDW, and albumin levels were included; those lacking labs and relevant data were excluded. Primary outcome was all cause mortality at index encounter, with secondary being 7,15 & 30-day readmissions. Predictors entered into logistic regression were descriptives, LAR, RAR, and PCI status. Model discrimination was assessed with the concordance statistic. We chose our LAR and RAR cutoff values as 0.5 and 4.65 respectively from previous studies.
RESULTS Elevated LAR and RAR each independently increased the odds of death after adjustment for demographics and PCI. For LAR, the odds of mortality were nearly tripled (OR 2.99, 95 % CI 2.62–3.42; p < 0.001). RAR exerted a significant, but comparatively smaller association, (OR 1.68, 95 % CI 1.50–1.89; p < 0.001). Female sex, non-White race, and receipt of PCI were protective (all p < 0.05). The full model achieved moderate discrimination (C = 0.708). Importantly, elevated LAR, but not RAR, predicted early clinical deterioration, being significantly associated with 7, 15 and 30-day readmissions.
CONCLUSION Both LAR more than RAR are powerful, readily obtainable predictors of short-term mortality in CHF patients recovering from AMI, with LAR also signaling readmission risk. Routine calculation of these ratios at admission could sharpen bedside prognostication & prompt increased surveillance. Incorporating ratios into post-AMI care warrants prospective validation and may foster a habit of leveraging routinely collected laboratory data for precision cardiac medicine.
Elevated LAR at index admission contrastingly was significantly associated with reduced with 7,15,30-day readmissions by 13-19% , possibly suggesting worse clinical presentations at index admission leading to prompt PCI. This, however, should be independently further evaluated through a much larger study for higher power by increasing the sample size. Interestingly, PCI at index encounter also had high association with 7-day readmissions, suggesting the need of detailed vigilance through clinical modalities prior to discharges.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Killedar, Amogh; Khan, Hamza; and Cusnir, Henry, "Lactate/Albumin and RDW/Albumin Ratios for Mortality and Readmission in Post-MI Heart Failure" (2025). East Florida Division GME Research Day 2025. 8.
https://scholarlycommons.hcahealthcare.com/eastflorida2025/8