Association Between Hemoglobin-to-Lactate Ratio and Mortality in Patients With Sepsis-Induced Myocardial Injury: A Retrospective Cohort Study Based on the MIMIC-IV Database

Background: Patients with sepsis-induced myocardial injury (SIMI) face a high risk of mortality. Although various biomarkers can be used to predict prognosis in SIMI patients, each has certain limitations. This study aimed to investigate the prognostic value of the hemoglobin-to-lactate (HLR) in patients with SIMI. Methods: This retrospective cohort study was conducted using data from the MIMIC-IV database. Patients diagnosed with SIMI who were admitted to the ICU were included. The HLR was calculated based on the first arterial blood gas analysis performed within 24 hours of ICU admission. Patients were divided into four groups based on the quartile,Kaplan-Meier analysis, multivariate regression models, and restricted cubic splines (RCS) were used to investigate the associations between HLR and different outcomes. Results: A total of 2,137 patients were included.28-day mortality and 90-Day mortality differs significantly across HLR groups (51.873%,38.764%,31.015%,and 22.905%, P <0.001).(56.554%,45.131%,39.474%,and30.540%, P <0.001).Multivariate regression analyses and Kaplan-Meier analysis found that lower HLR was significantly associated with greater mortality risk (log-rank P <0.001). Subgroup analyses similarly support this conclusion, The RCS Nonlinear analyses revealed an L-shaped association between HLR and mortality (28-day and 90-day), The cut-off values for HLR were 1.60 and 2.05. Conclusion: A lower HLR is associated with increased 28/90-day mortality in ICU patients with SIMI. The cut-off values (1.60 for 28-day mortality and 2.05 for 90-day mortality) suggest that HLR may serve as a useful prognostic indicator for identifying high-risk patients with sepsis-induced myocardial injury.