Delirium is a frequent and serious complication in critically ill patients with acute heart failure (HF). Reliable tools for early risk stratification may help identify patients at greater risk during intensive care unit (ICU) stay.

This retrospective observational cohort study, published in Clinical Cardiology, evaluated the association between the lactate-to-albumin ratio (LAR) and delirium using the Medical Information Mart for Intensive Care IV (MIMIC-IV-3.1) database, which included ICU admissions from 2008 to 2022. A total of 1,695 patients with acute HF were included. LAR was calculated by dividing serum lactate by serum albumin.

Bivariate analyses showed a significant association between higher LAR values and delirium incidence. Patients with higher LAR had greater delirium occurrence than those with lower values. Additional analyses using mediation methods and propensity score matching identified age, body mass index (BMI), and selected comorbidities as factors contributing to the observed association between LAR and delirium.

LAR may help identify acute HF patients at a higher likelihood of delirium during ICU admission. Further studies are needed to validate its clinical utility and determine whether LAR-guided strategies improve outcomes.