Background: This study aims to evaluate the predictive value of the lactate-to-albumin ratio (LAR) compared to PSI and CURB-65 scores in determining the need for ICU admission among hospitalised patients with community-acquired pneumonia.

Method: This was a single-centre retrospective cohort study. Adult patients (? 18 years old) diagnosed and hospitalised with community-acquired pneumonia between July 2021 and July 2023 were included. Patients were grouped and compared according to admission place [ward (n=64) or ICU (n=36)]. 

Results: The median age was 71 [64-77]. Patients admitted to the ICU were older (74.5 [62-83]) than patients admitted to the ward (65.5 [48.7-73.0]) (p=0.002).  LAR was higher in ICU patients (2.2 [1.4-3.2]) than in those admitted to the ward (1.2 [0.9-1.9]) (p<0.001). Overall, Hospital mortality was 20 %. Regarding the ICU admission, the AUC values of the PSI, CURB-65 scores and LAR were 0.823 (95% CI: 0.732-0.892) (p<0.001), 0.848 (0.763-0.912) (p<0.001) and 0.757 (95% CI: 0.661-838) (p<0.001), respectively. The PSI score displayed the highest sensitivity (69.4%), while the CURB-65 score had the greatest specificity (93.75%). There wasn?t any difference detected in pairwise comparisons of ROC curves. 

Conclusion: In this study, LAR was found to be a good predictor of ICU admissions in hospitalised patients with CAP and was non-inferior to PSI or CURB-65 scores. LAR was found to be a good predictor of ICU admissions in hospitalised patients with CAP and was non-inferior to PSI or CURB-65 scores.