BACKGROUND: Previous studies have identified the lactate dehydrogenase/albumin ratio (LAR) as an independent prognostic marker, significantly predicting in-hospital mortality in patients with inflammation and cancer. Building on this, the current study is designed to explore the association between LAR and mortality during hospitalization in patients with acute aortic dissection (AAD). METHODS: This retrospective study included patients diagnosed with AAD between January 1, 2010, and March 1, 2023. Patients were categorized into three groups based on LAR tertiles: T1 (<
5.01), T2 (5.01-6.43), and T3 (>
6.43). Multivariable logistic regression analysis was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (CIs). In addition, subgroup analysis, receiver operating characteristic (ROC) curves, decision curve analysis (DCA), clinical impact curve analysis, Boruta algorithm, and the Kaplan-Meier analysis were applied to analyze the data. RESULTS: A total of 2083 patients were enrolled in the study, with an average age of 53.20 ± 12.35 years, and male patients constituted 77%. After adjusting for relevant variables, ORs for in-hospital mortality were found to be 2.12 (95% CI: 1.34-3.36, p=0.002) for T2 and 2.30 (95% CI: 1.44-3.68, p<
0.002) for T3, compared to T1. The ROC curve, DCA analysis, Boruta algorithm, and Kaplan-Meier analysis demonstrated that the LAR exhibited a high level of concordance and practical applicability in forecasting in-hospital mortality. CONCLUSION: Elevated LAR is significantly associated with an increased risk of in-hospital mortality in patients with AAD. The results indicate that LAR may serve as a valuable predictor of adverse outcomes during hospitalization for these patients.