Association of admission lactate dehydrogenase-to-albumin ratio with acute pancreatitis recurrence after first-episode hypertriglyceridemia-induced acute pancreatitis: A multicenter retrospective cohort study

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ObjectiveHypertriglyceridemia-induced acute pancreatitis (HTG-AP) has a high recurrence rate, and recurrent episodes may result in repeated hospitalizations and long-term pancreatic complications. Simple admission-based markers for recurrence stratification remain limited. This study examined whether admission lactate dehydrogenase-to-albumin ratio (LAR) was associated with recurrence after first-episode HTG-AP.MethodsThis multicenter retrospective cohort study included consecutive patients with first-episode HTG-AP admitted to three tertiary hospitals between January 2020 and March 2025. Admission LAR was calculated as lactate dehydrogenase divided by serum albumin measured within 24 hours and categorized into tertiles. The primary outcome was recurrent acute pancreatitis during follow-up, defined as a new episode at least 3 months after remission of the index episode. Follow-up was censored at the last valid follow-up date or June 30, 2025. Associations were assessed using Cox models, restricted cubic splines, negative binomial regression, subgroup analyses, and propensity score overlap weighting.ResultsA total of 240 patients were included; the median age was 39 years, and 83.3% were male. During a median follow-up of 15.5 months (IQR, 8.0-27.0), 70 patients (29.17%) experienced recurrence, with a median recurrence interval of 9.5 months (IQR, 3.0-12.8). In the fully adjusted Cox model, higher LAR was associated with recurrence as a continuous variable (HR per unit increase, 1.05; 95% CI, 1.02-1.08; P = 0.002). The highest versus lowest LAR tertile was associated with higher recurrence hazard (HR, 2.62; 95% CI, 1.31-5.25; P = 0.007). Higher LAR was also associated with greater recurrence burden (IRR, 1.08; 95% CI, 1.04-1.11; P < 0.001). Subgroup and sensitivity analyses showed generally consistent findings.ConclusionsAdmission LAR was associated with recurrence and recurrence burden in patients with first-episode HTG-AP. As a simple and available admission-based marker, LAR may help identify patients who warrant closer post-discharge monitoring, although prospective validation is needed.

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