A new study published in theJournal of Inflammation Researchshowed that among patients with anticipated severe acute pancreatitis (SAP), a higher lactate dehydrogenase-to-albumin ratio (LAR) was linked to a higher in-hospital death rate. One possible predictive biomarker for predicting the course of severe acute pancreatitis (SAP) is the Lactate Dehydrogenase-to-Albumin Ratio. Reduced albumin suggests inadequate nutrition and inflammation, but elevated lactate dehydrogenase implies widespread tissue damage and inflammation. By combining inflammatory and metabolic reactions, LAR provides a more complete measure of the severity of the illness. According to recent research, among patients with anticipated SAP, a larger LAR is substantially linked to higher in-hospital mortality. For early risk stratification and management optimization in SAP, LAR offers a quick, easy, and affordable solution because standard scoring methods can be complicated or slow. To evaluate the usefulness of LAR in predicting mortality risk, which may aid in early treatment and more accurate medical methods, this study carried out this extensive investigation on patients with anticipated SAP. A retrospective analysis was conducted on 4605 patients (APACHE II > 8) who were admitted to Nanchang University's First Affiliated Hospital between 2005 and 2023. In-hospital mortality was independently predicted by elevated LAR (adjusted HR per SD: 1.14; 95% CI: 1.09–1.19; P < 0.001). High-LAR groups had substantially poorer survival, according to Kaplan-Meier curves (P < 0.05). LAR (AUC = 0.847; 95% CI: 0.826–0.869) fared better than LDH, albumin, SIRS, and APACHE II. There was found to be a non-linear correlation with a threshold at LAR = 20.58. For both short-term (≤ 14 days) and long-term (30–90 days) mortality, the predictive value was constant across etiologies. The patients with hypertriglyceridemia who were younger, male, and did not have persistent multiple organ failure showed stronger correlations. Overall, acceptance for patients with anticipated SAP, LAR seems to be a viable biomarker for predicting in-hospital mortality. When compared to its separate components (LDH and albumin) and numerous conventional clinical scoring systems, it exhibits consistent predictive performance across a range of periods and etiologies of AP and offers higher accuracy. Zou, Y., Kuang, M., Xiong, S., Xu, X., Li, X., Ding, L., He, C., Li, N., Ke, H., Huang, X., Lei, Y., Xiong, H., He, W., Xia, L., Lu, N., Wan, J., & Zhu, Y. (2025b). Lactate dehydrogenase-to-albumin ratio as a predictor of in-hospital mortality in predicted severe acute pancreatitis: Evidence from an 18-year cohort study. Journal of Inflammation Research, 18, 14927–14939.https://doi.org/10.2147/jir.s546481