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Background Accurate early risk stratification remains a major challenge in patients with acutely decompensated liver cirrhosis. Lactate reflects tissue hypoxia and impaired hepatic clearance, while serum albumin represents hepatic synthetic function and nutritional status. The lactate/albumin ratio (LAR) has recently emerged as a potential prognostic biomarker in critically ill patients.Aim To evaluate the prognostic value of the lactate/albumin ratio in hospitalized patients with acutely decompensated cirrhosis and to assess its ability to predict 28-day and 3-month mortality in comparison with established prognostic scoring systems.Methods This prospective observational study included 380 adult patients with decompensated liver cirrhosis admitted to the Hepatology and Gastroenterology Department at the National Liver Institute, Menoufia University. Serum lactate and albumin levels were measured at admission, and the lactate/albumin ratio was calculated. Patients were prospectively followed for 28 days and 3-month all-cause mortality. Multivariable logistic regression and receiver operating characteristic (ROC) curve analyses were performed to evaluate prognostic performance.Results The mean lactate/albumin ratio was 2.38 ± 0.71. ROC curve analysis demonstrated that the lactate/albumin ratio showed moderate discriminative ability for predicting 28-day mortality (sensitivity 60%, specificity 81.4% at a cut-off value of 2.825; p = 0.001) and 3-month mortality (sensitivity 68.9%, specificity 78.4% at a cut-off value of 2.435; p < 0.001). However, in multivariable regression analysis, the MELD score was the only independent predictor of mortality, while the lactate/albumin ratio did not retain independent prognostic significance.Conclusions An elevated lactate/albumin ratio is associated with increased short-term mortality in patients with acutely decompensated cirrhosis but does not independently predict mortality after adjustment for established prognostic scores. The lactate/albumin ratio may serve as a complementary prognostic marker alongside a validated scoring system.