Kudu E, Altun M, Karacabey S. Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review. World J Crit Care Med 2026; 15(3): 123634 [DOI: 10.5492/wjccm.123634]
Corresponding Author of This Article
Emre Kudu, MD, Associate Professor, Researcher, Department of Emergency Medicine, Marmara University School of Medicine, Muhsin Yazıcıoğlu Caddesi, No. 10 Üst Kaynarca, İstanbul 34899, Pendik, Türkiye. dr.emre.kudu@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
review-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Kudu E, Altun M, Karacabey S. Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review. World J Crit Care Med 2026; 15(3): 123634 [DOI: 10.5492/wjccm.123634]
World J Crit Care Med. Sep 9, 2026; 15(3): 123634 Published online Sep 9, 2026. doi: 10.5492/wjccm.123634
Lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index in acute and critical care: A focused mini-review
Emre Kudu, Mustafa Altun, Sinan Karacabey
Emre Kudu, Mustafa Altun, Sinan Karacabey, Department of Emergency Medicine, Marmara University School of Medicine, İstanbul 34899, Pendik, Türkiye
Author contributions: Kudu E designed overall concept, outline, and design of the manuscript, led the writing of the manuscript, and performed the literature investigation; Altun M and Karacabey S aided in the literature search, engaged in the interpretation and discussion of the findings, and meticulously revised and refined the manuscript. All authors read and approved the final version of the manuscript to be published.
AI contribution statement: Grammarly was used solely for language checking, grammar correction, and minor language refinement during manuscript preparation. All suggested language edits were carefully reviewed, verified, and approved by the authors, who take full responsibility for the accuracy, originality, and scientific content of the manuscript. OpenAI ChatGPT was used to assist in the generation of Figure 1, based on the conceptual framework developed by the authors. 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. The final figure was carefully reviewed, edited, and approved by the authors to ensure scientific accuracy, originality, and appropriateness for publication. The authors carefully reviewed the final figure, verified the accuracy of the scientific content and visual representation, and approved it for submission. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions. The authors take full responsibility and accountability for all content of the manuscript and submitted materials.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Emre Kudu, MD, Associate Professor, Researcher, Department of Emergency Medicine, Marmara University School of Medicine, Muhsin Yazıcıoğlu Caddesi, No. 10 Üst Kaynarca, İstanbul 34899, Pendik, Türkiye. dr.emre.kudu@gmail.com
Received: May 25, 2026 Revised: June 20, 2026 Accepted: June 29, 2026 Published online: September 9, 2026 Processing time: 90 Days and 1.5 Hours
Abstract
Risk stratification in acute and critical care increasingly relies on accessible biomarkers that capture multiple dimensions of physiological stress. Albumin-based composite biomarkers have gained attention because serum albumin reflects not only nutritional reserve but also systemic inflammation, hepatic synthetic capacity, endothelial permeability, capillary leakage, and resuscitation-related volume shifts. Among these indices, the lactate-to-albumin ratio, C-reactive protein-to-albumin ratio (CAR), and prognostic nutritional index (PNI) are particularly practical because they combine albumin with markers of tissue hypoperfusion, inflammatory burden, and immune-nutritional status. This focused mini-review presents a narrative synthesis of literature identified through targeted searches of PubMed, Web of Science, and Google Scholar using terms related to these indices and acute or critical care populations. Evidence suggests that elevated lactate-to-albumin and CARs and reduced PNI are generally associated with mortality, organ dysfunction, intensive care requirement, postoperative complications, and prolonged hospitalization in emergency department, intensive care, perioperative, infectious, cardiovascular, respiratory, gastrointestinal, trauma, and oncological settings. However, interpretation is limited by disease heterogeneity, variable sampling times, resuscitation-related albumin changes, hepatic dysfunction, chronic inflammation, inconsistent cutoff values, and the predominance of retrospective and observational evidence. These indices should therefore be interpreted as supportive prognostic markers within the broader clinical context rather than as replacements for clinical judgment or validated prognostic models.
Core Tip: The lactate-to-albumin ratio, C-reactive protein-to-albumin ratio, and prognostic nutritional index may help clinicians interpret routinely available laboratory results within a broader biological framework that includes metabolic stress, inflammation, albumin biology, and immune nutritional reserve. Their greatest potential value is not as standalone decision tools, but as adjuncts to bedside assessment and established severity scores. Future studies should determine whether serial measurements, disease specific thresholds, and integration into existing prognostic models improve clinical decision making and patient risk stratification.
