Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review

Figure 1 Biological framework of albumin-based composite biomarkers in acute and critical care. This figure illustrates how inflammation, capillary leakage, hepatic synthesis, fluid shifts, nutritional reserve, physiological stress, and organ dysfunction influence serum albumin and contribute to the interpretation of lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index. Lactate-to-albumin ratio mainly reflects tissue hypoperfusion and metabolic stress relative to albumin-related reserve, C-reactive protein-to-albumin ratio reflects systemic inflammatory burden relative to albumin-related reserve, and prognostic nutritional index reflects immune-nutritional vulnerability through albumin and lymphocyte count. These indices may assist risk stratification for mortality, intensive care unit admission, organ failure, complications, length of stay, and treatment response, but should be interpreted in light of clinical context and major confounding factors. IL-6: Interleukin-6; TNF-α: Tumor necrosis factor-α; CRP: C-reactive protein; LAR: Lactate-to-albumin ratio; CAR: C-reactive protein-to-albumin ratio; PNI: Prognostic nutritional index; ICU: Intensive care units. The figure was conceptually developed by the authors and generated with the assistance of OpenAI ChatGPT. It was used only as an assistive tool for generating the visual components of the figure. The overall concept, scientific content, organization, structure, labels, abbreviations, and explanatory elements were developed by the authors.