Intensive care unit (ICU) patients suffering from cerebrovascular disease are subject to a high mortality risk. The existing prognostic tools are characterized by their complexity and limited universality and timeliness. The lactate albumin ratio (LAR) has been shown to integrate tissue perfusion (lactate) and nutritional-inflammatory status (albumin), with the potential to serve as a simple, cost-effective risk stratification indicator. The present study evaluated the relationship between LAR and all-cause mortality during hospitalization and in the ICU among critically ill patients with cerebrovascular disease, and compared its predictive performance with that of commonly used inflammatory markers. We identified 873 ICU patients with cerebrovascular disease from MIMIC-IV 3.0 and stratified them into LAR tertiles. Primary outcomes were in-hospital and ICU all-cause mortality. Associations between LAR and outcomes were assessed using Cox models, Kaplan-Meier curves, and restricted cubic splines; predictive performance was evaluated by receiver operating characteristic analysis. The Kaplan-Meier analysis revealed a significant association between an increase in LAR level and a decrease in survival rate. In the fully adjusted model, for every 1-unit increase in LAR, the risk of in-hospital death increased by 15% (HR = 1.15, 95% CI = 1.07-1.23, P < .001), and the risk of ICU death also increased by 15% (HR = 1.15, 95% CI = 1.06-1.24, P < .001). The restricted cubic spline analysis confirmed that LAR was approximately linearly positively correlated with the risk of death, and this relationship remained consistent across all subgroups. The area under the curve value of LAR was 0.68 (95% CI = 0.64-0.71), which was superior to traditional inflammatory indicators (platelet-to-lymphocyte ratio (PLR), lymphocyte ratio (NLR), systemic inflammation response index (SIRI), systemic inflammation index (SII)). The present study has demonstrated that LAR is an independent risk factor for in-hospital mortality in patients with cerebrovascular diseases, showing a nearly linear positive correlation. Its predictive performance has been demonstrated to exceed that of conventional inflammatory indicators (PLR, NLR, SIRI, SII). LAR's simplicity of measurement and low cost suggests that it will serve as a supplementary tool for early risk stratification in the ICU.