Abstract
Background
Early identification of diabetic foot infection (DFI) patients at risk for clinical deterioration is critical for timely intervention. Serum lactate reflects tissue hypoperfusion, whereas hypoalbuminemia indicates systemic inflammation and poor nutritional status. The aim of this study is to evaluate the ability of the lactate-to-albumin ratio (LAR) to predict ICU admission in patients with DFI.
Methods
This retrospective study was conducted in the emergency department of a tertiary care center between 01.01.2022 and 01.01.2025. Adult patients (≥18 years) with confirmed DFI were included. DFI diagnosis was established
Results
Among 494 patients (median age, 64 years; 40.3% female), 91 (18.4%) required ICU admission. ICU patients had higher lactate (2.5 vs 1.8 mmol/L, P < .001), lower albumin (3.2 vs 3.4 g/dL, P < .001), and higher LAR (0.8 vs 0.5, P < .001). LAR demonstrated the best discrimination for ICU admission (AUC, 0.717; 95% CI, 0.658-0.777), outperforming albumin (AUC, 0.626; P = .009) and similar to lactate (AUC, 0.702; P = .134). A cut-off of ≥0.73 yielded 57.1% sensitivity and 78.2% specificity. LAR (OR, 1.36; 95% CI, 1.16-1.58; P < .001), older age, lower mean arterial pressure, and lower ankle–brachial index were independent predictors of ICU admission.
Conclusions
The lactate-to-albumin ratio is a simple, cost-effective biomarker that independently predicts ICU admission in DFI patients and may aid early risk stratification. Although LAR did not demonstrate statistically superior discrimination over lactate alone, it integrates systemic metabolic stress with the host's inflammatory and nutritional reserve, offering a composite measure of physiological vulnerability in this high-risk population.
Keywords
Get full access to this article
View all access options for this article.