1
|
Feng L, Liu S, Wang J, Gao Y, Xie F, Gong J, Bi S, Yao Z, Li Y, Liu W, Guan C, Zhang M, Wang H, Zheng J. The performance of a combination of heparin-binding protein with other biomarkers for sepsis diagnosis: an observational cohort study. BMC Infect Dis 2024; 24:755. [PMID: 39080540 PMCID: PMC11290073 DOI: 10.1186/s12879-024-09666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 07/25/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND HBP, a novel biomarker released from neutrophils, may induce inflammatory responses and exacerbate vascular permeability, representing the pathophysiological characteristics of sepsis and septic shock. However, it remains uncertain whether the combination of HBP with other biomarkers yields enhanced diagnostic capacity for sepsis. We hypothesized that measurements included IL-6·IL-8·HBP, IL-6·IL-8·HBP/ALB and HBP/ALB which based on HBP will improve its diagnostic efficacy and even better than the traditional infection biomarkers. METHODS Between July 2021 and June 2022, we carried out a comprehensive, multi-center, observational cohort study spanning six leading tertiary hospitals located in Heilongjiang Province, China. Patients were stratified into three categories based on the severity of infection: non-sepsis, sepsis, and septic shock. We collected clinical and laboratory data, along with infection and inflammation biomarkers, for analysis. RESULTS A total of 195 patients were enrolled. Among the three groups, patients with septic shock (n = 75, 38.5%) had significantly higher baseline levels of HBP, WBC, Lac, CRP, PCT, IL-6, IL-8, and IL-10 compared to non-sepsis patients (n = 43, 22.0%) and sepsis patients (n = 77, 39.5%), with statistically significant differences (p < 0.05) observed for all parameters. When compared to SOFA score and traditional markers of CRP, PCT, IL-6 and IL-8, the combined indexes of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB demonstrated significantly improved diagnostic performance for sepsis and septic shock (AUC 0.911 and 0.902 respectively, p < 0.001). CONCLUSIONS The combined measurements of IL-6·IL-8·HBP and IL-6·IL-8·HBP/ALB can augment the diagnostic capacity of HBP for sepsis, and offer reliable early supplementary indicators to traditional biomarkers for assessing disease severity in patients with infection.
Collapse
Affiliation(s)
- Liwei Feng
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
- Department of Intensive Care Medicine, The Arong Banner People's Hospital, Hulunbuir, Inner Mongolia Autonomous Region, 162750, China
| | - Shujie Liu
- Department of Intensive Care Medicine, The Second People's Hospital of Mudanjiang, Mudanjiang, Heilongjiang, 157000, China
| | - Jieying Wang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Yan Gao
- Department of Intensive Care Medicine, The Fouth Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150001, China
| | - Fengjie Xie
- Department of Intensive Care Medicine, Hongqi Hospital Affiliated to Mudanjiang Medical University, Mudanjiang, Heilongjiang, 157011, China
| | - Jianguo Gong
- Department of Intensive Care Medicine, The People's Hospital of Daqing, Daqing, Heilongjiang, 163711, China
| | - Sheng Bi
- Department of Intensive Care Medicine, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, 161005, China
| | - Zhipeng Yao
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Yue Li
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Wenhua Liu
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Chunming Guan
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Ming Zhang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China
| | - Hongliang Wang
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China.
| | - Junbo Zheng
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, 150081, China.
| |
Collapse
|
2
|
Fu Y, Wang Y, Tang W, Yang Q, Wang G, Li M. Clinical characteristics and risk factors for poor outcomes of invasive pneumococcal disease in pediatric patients in China. BMC Infect Dis 2024; 24:602. [PMID: 38898407 PMCID: PMC11186143 DOI: 10.1186/s12879-024-09493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/11/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) is a significant health concern in children worldwide. In this study, we aimed to analyze the clinical features, antibiotic resistance, and risk variables for poor outcomes in patients with IPD in Hangzhou. METHODS A retrospective single-centre study was performed using the pediatric intensive care (PIC) database from 2010 to 2018. The clinical characteristics, laboratory data, antimicrobial resistance, and risk factors for in-hospital mortality and sepsis in patients with IPD in intensive care units (ICUs) were analyzed systematically. RESULTS A total of 178 IPD patients were included in the study. The majority of the IPD children were 2-10 years old. Antimicrobial resistance tests of S. pneumoniae isolates revealed high resistance to erythromycin, tetracycline and compound sulfamethoxazole (SMZ-Co). All the isolates were sensitive to vancomycin, linezolid, moxifloxacin, telithromycin, ofloxacin, and levofloxacin. IPD patients may experience poor outcomes, including death and sepsis. The in-hospital mortality was 3.93%, and 34.27% of patients suffered from sepsis. Temperature (OR 3.80, 95% CI 1.62-8.87; P = 0.0021), Partial Pressure of Oxygen in Arterial Blood (PaO2) (OR 0.99, 95% CI 0.98-1.00; P = 0.0266), and albumin (OR 0.89, 95% CI 0.80-0.99; P = 0.0329) were found to be independent risk factors for sepsis in children with IPD. CONCLUSION Pediatric IPD deserves attention in China. Appropriate surveillance and antibiotic selection are crucial in managing resistant strains. Early identification of high-risk individuals with risk factors contributes to the development of appropriate treatment strategies.
Collapse
Affiliation(s)
- Yanan Fu
- Department of Medical Engineering, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yingchun Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Wei Tang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Qing Yang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Guan Wang
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China
| | - Meng Li
- Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, Jinan, 250012, Shandong Province, China.
| |
Collapse
|
3
|
You WJ, Lian TT, Qian O, Wei JJ, Zhuang ZH. Retrospective study of 189 cases of acute perforated peptic ulcer: safety and efficacy of over-the-scope-clip based endoscopic closure. Surg Endosc 2024:10.1007/s00464-024-10982-w. [PMID: 38886229 DOI: 10.1007/s00464-024-10982-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND To compare the clinical outcomes in patients with acute perforated peptic ulcer (PPU) treated with over-the-scope clip (OTSC), non-surgical, and surgical interventions, and to explore the effectiveness and safety of OTSC closure. METHODS Hospital stay, antibiotic use, diet resumption time, and mortality rate were analyzed retrospectively. Binary Logistic regression analysis was used to identify the risk factors influencing PPU complicated with sepsis. RESULTS Patients were divided into three treatment groups: OTSC (n = 62), non-surgical (n = 72), and surgical (n = 55) groups. The median time (IQR) from symptom onset to admission was 9.0 (4-23) h. 88.71% (55/62) of the patients in In the OTSC group underwent OTSC closure within 24 h (median [IQR] time: 14.5 [7.00-30.25] h). The perforation diameters in the OTSC and surgical groups were 9.87 mm ± 5.97 mm and 8.55 mm ± 6.17 mm, respectively. The median (IQR) hospital stays in the OTSC (9.50 [7.00-12.25] days) and non-surgical group (9.00[7.00-13.00]days) were similar (p > 0.05), but shorter than that in surgical group (12.00[10.00-16.00]days), (p < 0.05). The median duration of antibiotic use was shorter in the OTSC group (7.00[3.00-10.00]) than in the non-surgical group (9.00[7.00-11.00]) and surgical group (11.00[9.00-13.00]) ( p < 0.05); and the time to resume oral feeding was shorter in the OTSC group (4.00[2.00-5.25]) than in the non-surgical group (7.00[6.13-9.00]) and surgical group (8.00[6.53-10.00]), respectively ( p < 0.05). No mortality difference among groups (p = 0.109) was found. Lower albumin level at admission, older age, and elevated creatinine levels were associated with increased sepsis risk, with OR(95%CI) of 0.826 (0.687-0.993), 1.077 (1.005-1.154), and 1.025 (1.006-1.043), respectively (all p < 0.05). CONCLUSION OTSC closure improves clinical outcomes of acute PPU patients without sepsis. Age, hypoalbuminemia, and baseline renal dysfunction increase the risk of sepsis, while mortality was associated with sepsis and multiorgan dysfunction.
Collapse
Affiliation(s)
- Wei-Jia You
- Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Ting-Ting Lian
- Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Ou Qian
- Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Jing-Jing Wei
- Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China
| | - Ze-Hao Zhuang
- Endoscopic Center, The First Affiliated Hospital of Fujian Medical University, No. 20, Chazhong Road, Fuzhou, 350004, Fujian, China.
| |
Collapse
|
4
|
Wei J, Zeng R, Liang R, Liu S, Hua T, Xiao W, Zhu H, Liu Y, Yang M. Construction and validation of a nomogram prediction model for the progression to septic shock in elderly patients with urosepsis. Heliyon 2024; 10:e32454. [PMID: 38961944 PMCID: PMC11219351 DOI: 10.1016/j.heliyon.2024.e32454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 07/05/2024] Open
Abstract
Background Septic shock is a clinical syndrome characterized by the progression of sepsis to a severe stage. Elderly patients with urosepsis in the intensive care unit (ICU) are more likely to progress to septic shock. This study aimed to establish and validate a nomogram model for predicting the risk of progression to septic shock in elderly patients with urosepsis. Methods We extracted data from the Medical Information Mart for Intensive Care (MIMIC-IV) and the eICU Collaborative Research Database (eICU-CRD). The MIMIC-IV dataset was split into a training set for model development and an internal validation set to assess model performance. Further external validation was performed using a distinct dataset sourced from the eICU-CRD. Predictors were screened using least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses. The evaluation of model performance included discrimination, calibration, and clinical usefulness. Results The study demonstrated that the Glasgow Coma Scale (GCS), white blood count (WBC), platelet, blood urea nitrogen (BUN), calcium, albumin, congestive heart failure (CHF), and invasive ventilation were closely associated with septic shock in the training cohort. Nomogram prediction, utilizing eight parameters, demonstrated strong predictive accuracy with area under the curve (AUC) values of 0.809 (95 % CI 0.786-0.834), 0.794 (95 % CI 0.756-0.831), and 0.723 (95 % CI 0.647-0.801) in the training, internal validation, and external validation sets, respectively. Additionally, the nomogram demonstrated a promising calibration performance and significant clinical usefulness in both the training and validation sets. Conclusion The constructed nomogram is a reliable and practical tool for predicting the risk of progression to septic shock in elderly patients with urosepsis. Its implementation in clinical practice may enhance the early identification of high-risk patients, facilitate timely and targeted interventions to mitigate the risk of septic shock, and improve patient outcomes.
Collapse
Affiliation(s)
- Jian Wei
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
| | - Ran Zeng
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Department of Intensive Care Unit, Fuyang Hospital of Anhui Medical University, 99 Huangshan Road, Fuyang, 236000, Anhui province, China
| | - Ruiyuan Liang
- Key Laboratory of Intelligent Computing & Signal Processing, Ministry of Education, Anhui University, 111 Jiulong Road, Hefei, 230601, Anhui Province, China
- School of Integrated Circuits, Anhui University, 111 Jiulong Road, Hefei, 230601, Anhui Province, China
| | - Siying Liu
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
| | - Tianfeng Hua
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
| | - Wenyan Xiao
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
| | - Huaqing Zhu
- Laboratory of Molecular, Biology and Department of Biochemistry, Anhui Medical University, 81 Meishan Road, Hefei, 230022, Anhui Province, China
| | - Yu Liu
- Key Laboratory of Intelligent Computing & Signal Processing, Ministry of Education, Anhui University, 111 Jiulong Road, Hefei, 230601, Anhui Province, China
- School of Integrated Circuits, Anhui University, 111 Jiulong Road, Hefei, 230601, Anhui Province, China
| | - Min Yang
- The Second Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Laboratory of Cardiopulmonary Resuscitation and Critical Care, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
| |
Collapse
|
5
|
Wang J, Li H, Luo H, Shi R, Chen S, Hu J, Luo H, Yang P, Cai X, Wang Y, Zeng X, Wang D. Association between serum creatinine to albumin ratio and short- and long-term all-cause mortality in patients with acute pancreatitis admitted to the intensive care unit: a retrospective analysis based on the MIMIC-IV database. Front Immunol 2024; 15:1373371. [PMID: 38686375 PMCID: PMC11056558 DOI: 10.3389/fimmu.2024.1373371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Background Serum creatinine (Cr) and albumin (Alb) are important predictors of mortality in individuals with various diseases, including acute pancreatitis (AP). However, most previous studies have only examined the relationship between single Cr or Alb levels and the prognosis of patients with AP. To our knowledge, the association between short- and long-term all-cause mortality in patients with AP and the blood creatinine to albumin ratio (CAR) has not been investigated. Therefore, this study aimed to evaluate the short- and long-term relationships between CAR and all-cause mortality in patients with AP. Methods We conducted a retrospective study utilizing data from the Medical Information Market for Intensive Care (MIMIC-IV) database. The study involved analyzing various mortality variables and obtaining CAR values at the time of admission. The X-tile software was used to determine the optimal threshold for the CAR. Kaplan-Meier (K-M) survival curves and multivariate Cox proportional hazards regression models were used to assess the relationship between CAR and both short- and long-term all-cause mortality. The predictive power, sensitivity, specificity, and area under the curve (AUC) of CAR for short- and long-term mortality in patients with AP after hospital admission were investigated using Receiver Operating Characteristic analysis. Additionally, subgroup analyses were conducted. Results A total of 520 participants were included in this study. The CAR ideal threshold, determined by X-tile software, was 0.446. The Cox proportional hazards model revealed an independent association between CAR≥0.446 and all-cause mortality at 7-day (d), 14-d, 21-d, 28-d, 90-d, and 1-year (y) before and after adjustment for confounders. K-M survival curves showed that patients with CAR≥0.446 had lower survival rates at 7-d, 14-d, 21-d, 28-d, 90-d, and 1-y. Additionally, CAR demonstrated superior performance, with higher AUC values than Cr, Alb, serum total calcium, Glasgow Coma Scale, Systemic Inflammatory Response Syndrome score, and Sepsis-related Organ Failure Assessment score at 7-d, 14-d, 21-d, 28-d, 90-d, and 1-y intervals. Subgroup analyses showed that CAR did not interact with a majority of subgroups. Conclusion The CAR can serve as an independent predictor for short- and long-term all-cause mortality in patients with AP. This study enhances our understanding of the association between serum-based biomarkers and the prognosis of patients with AP.
Collapse
Affiliation(s)
- Jianjun Wang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- National Health Commission (NHC) Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Han Li
- Department of Cardiology, The Fifth Hospital of Wuhan, Wuhan, China
| | - Huiwen Luo
- National Health Commission (NHC) Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Ruizi Shi
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Sirui Chen
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Junchao Hu
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Hua Luo
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Pei Yang
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xianfu Cai
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yaodong Wang
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Xintao Zeng
- Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Decai Wang
- National Health Commission (NHC) Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- Department of Urology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| |
Collapse
|
6
|
Mousa N, Salah M, Elbaz S, Elmetwalli A, Elhammady A, Abdelkader E, Abdelsalam M, El-Wakeel N, Mansour M, Hashem M, El-Emam O, Elderiny W, Abdelaziz M, Elgamal A, Habib A. Neutrophil percentage-to-albumin ratio is a new diagnostic marker for spontaneous bacterial peritonitis: a prospective multicenter study. Gut Pathog 2024; 16:18. [PMID: 38561807 PMCID: PMC10985869 DOI: 10.1186/s13099-024-00610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The neutrophil percentage-to-albumin ratio (NPAR) is a novel measure of systemic inflammation and infection. Low albumin levels increase the risk of infection, while high neutrophil counts indicate the presence of infection. Spontaneous bacterial peritonitis (SBP) is a serious infection in cirrhotic ascites, and the potential of NPAR in diagnosing SBP is not yet established. OBJECTIVE The objective of this study is to determine the diagnostic value of NPAR in identifying SBP. PATIENTS This prospective multicenter study included 465 patients diagnosed with cirrhotic ascites and SBP according to international guidelines. Demographic, clinical, and laboratory data were collected. The sensitivity and specificity of NPAR values for diagnosing SBP were assessed using the receiver operating characteristic curve. RESULTS For SBP diagnosis in the total cohort, NPAR of > 17 had a sensitivity of 85.71%, specificity of 66.67%, and 95% CI (42.1-99.6). In culture-positive SBP, the NPAR at a cut-off > 5.2 had a sensitivity of 85.71%, specificity of 83.33%, and 95% CI (0.709 to 0.979), while in culture-negative SBP, the NPAR at a cut-off > 2.1 had a sensitivity of 92.86%, specificity of 33.33% and CI (0.367 to 0.764). The multivariate analysis revealed that albumin (OR = 2.78, [1.11;3.98], INR (OR = 0.198, [0.066;0.596], creatinine (OR = 0.292, [0.1; 0.81], CRP (OR = 3.18, [1.239;4.52] total leukocytic count (TLC) (OR = 1.97, [1.878; 2.07], platelets (OR = 2.09, [0.99; 2.31] and neutrophil (OR = 3.43, [1.04;3.89] were significantly associated with higher prediction rates for culture positive SBP. CONCLUSIONS NPAR could be a new, affordable, noninvasive test for diagnosing SBP.
Collapse
Affiliation(s)
- Nasser Mousa
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Mohamed Salah
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Sherif Elbaz
- Endemic Diseases and Gastroenterology Department, Aswan University, Aswan, Egypt
| | - Alaa Elmetwalli
- Department of Clinical Trial Research Unit and Drug Discovery, Egyptian Liver Research Institute and Hospital (ELRIAH), Mansoura, Egypt
| | - Amr Elhammady
- Internal Medicine Department, Banha University, Benha, Egypt
| | - Eman Abdelkader
- Internal Medicine Department, Mansoura University, Mansoura, Egypt
| | | | - Niveen El-Wakeel
- Medical Microbiology and Immunology Department, Mansoura University, Mansoura, Egypt
- Department of Basic Medical Sciences, Faculty of Medicine, New Mansoura University, New Mansoura, Egypt
| | - Marwa Mansour
- Internal Medicine Department, Mansoura University, Mansoura, Egypt
| | - Manal Hashem
- Internal medicine department, Zagazig University, Zagazig, Egypt
| | - Ola El-Emam
- Clinical Pathology Department, Mansoura University, Mansoura city, Egypt
| | - Wesam Elderiny
- Clinical Pathology Department, Mansoura University, Mansoura city, Egypt
| | - Mohammed Abdelaziz
- Tropical Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ayman Elgamal
- Department of Tropical Medicine, Menoufia University, Menoufia, Egypt
| | - Alaa Habib
- Internal Medicine Department, Mansoura University, Mansoura, Egypt
| |
Collapse
|
7
|
Kumar HG, Kanakaraju K, Manikandan VAC, Patel V, Pranay C. The Relationship Between Serum Albumin Levels and Sepsis in Patients Admitted to a Tertiary Care Center in India. Cureus 2024; 16:e59424. [PMID: 38826606 PMCID: PMC11140419 DOI: 10.7759/cureus.59424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Sepsis poses a significant threat in Indian hospitals, with high mortality rates and complications. This study explores the correlation between serum albumin levels and sepsis outcomes in an intensive care unit (ICU) setting. The challenges of diagnosing tropical infections further complicate sepsis management in India. Methodology A longitudinal study was conducted at Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, India. Adult patients admitted between July 2020 and March 2021 with sepsis were included. Serum albumin levels, demographic data, and clinical outcomes were analyzed. The study used a convenient sampling technique with a sample size of 102 patients. Results Among the 102 patients in the ICU, 22 have expired and the mortality rate in the study was 21.6%. Hypoalbuminemia was present in 56.9% (n = 58) of the patients. The mortality rate is higher among the sepsis patients with the occurrence of hypoalbuminemia (29.3%) compared to patients without hypoalbuminemia (11.4%) and the difference in proportion between the two groups was statistically significant (p-value = 0.029). The requirement of vasopressor support is higher among sepsis patients with the occurrence of hypoalbuminemia (56.9%) compared to patients without hypoalbuminemia (27.3%). The chi-square test reveals that the difference in proportion between the two groups was statistically significant (p-value = 0.005). No substantial impact on systemic inflammatory response scores, readmission to ICU, or progression to chronic illness was observed based on albumin levels. Conclusion This study underscores the predictive value of hypoalbuminemia in sepsis outcomes. Patients with decreased albumin levels showed higher mortality rates and increased vasopressor usage. While albumin levels did not significantly influence certain parameters, hypoalbuminemia may serve as an indicator of severity and adverse prognosis in sepsis, emphasizing the need for further research and tailored interventions.
Collapse
Affiliation(s)
- Hemanth G Kumar
- Internal Medicine, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, IND
| | - Kirubhakaran Kanakaraju
- General Medicine, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, IND
| | - Vaiera A C Manikandan
- Internal Medicine, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, IND
| | - Vishal Patel
- Internal Medicine, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, IND
| | - Chittimalla Pranay
- Internal Medicine, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, IND
| |
Collapse
|
8
|
Yin W, Fang C, Fan X, Chen Y. Albumin and C-reactive protein as diagnostic markers for neonatal sepsis: a retrospective study. J Int Med Res 2024; 52:3000605241238993. [PMID: 38530043 DOI: 10.1177/03000605241238993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To assess the applicability of albumin (ALB) and C-reactive protein (CRP) concentrations in the diagnosis of sepsis in neonates on the day of admission, and to help with early identification and intervention in the development of sepsis. METHODS This retrospective study included all neonates who were admitted to the neonatal intensive care unit from January 2020 to June 2023. We studied 160 full-term neonates, including 80 with sepsis and 80 healthy controls. A multivariate analysis was conducted to evaluate the associations between ALB, CRP, and sepsis. RESULTS CRP concentrations were significantly higher in neonates with sepsis than in controls (26.5 ± 8.6 vs. 3.6 ± 1.2 ng/L). At a cut-off point of 10.8 ng/L, CRP showed a sensitivity of 74.3% and a specificity of 80%. Moreover, ALB concentrations were significantly lower in neonates with sepsis than in controls (25.4 ± 2.5 g/L vs. 29.2 ± 2.6 g/L). At a cut-off point of 26.8, ALB showed a sensitivity of 75.6% and a specificity of 84.2%. CONCLUSIONS Our findings suggest that ALB and CRP concentrations on the first day of admission are different between neonates who do and those who do not develop sepsis. Higher CRP concentrations and lower ALB concentrations may indicate an increased risk of sepsis.
Collapse
Affiliation(s)
- Wei Yin
- Department of Pediatrics, Linping Branch, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - ChengChao Fang
- Department of Pediatrics, Linping Branch, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Xiaoping Fan
- Department of Pediatrics, Linping Branch, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | | |
Collapse
|
9
|
Tan Y, Xiang W, Chen Y, Huang J, Sun D. Effect of hypoproteinemia on mortality of elderly male patients with chronic heart failure. Medicine (Baltimore) 2024; 103:e37078. [PMID: 38306508 PMCID: PMC10843509 DOI: 10.1097/md.0000000000037078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/05/2024] [Indexed: 02/04/2024] Open
Abstract
To explore the effect of hypoproteinemia on cardiac function and prognosis in elderly male patients with chronic heart failure. Among the patients with chronic heart failure hospitalized in the General Hospital of Southern Theater Command from December 2014 to December 2015, 100 elderly male patients with chronic heart failure were selected. The patients were divided into 2 groups based on their serum albumin (ALB) levels: 53 cases in the normal group (ALB ≥ 35 g/L) and 47 cases in the hypoproteinemia group (ALB < 35 g/L). Using the method of prospective study, under the condition of routine treatment of heart failure, follow-up observation for 5 years, we collected relevant data and analyzed the level of serum ALB, cardiac function and prognosis of patients in these 2 groups. The mortality of patients in the hyporoteinemia group were significantly higher than those in the normal group. Left ventricular end-diastolic dimension (LVDD) and brain natriuretic peptide (BNP) in the normal group after 5 years were markedly lower compared with that in the hypoproteinemia group. The mortality of patients with chronic heart failure with hypoproteinemia were higher, and the present study indicated that the ALB level may be associated with the mortality of patients with chronic heart failure.
Collapse
Affiliation(s)
- Yan Tan
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Wei Xiang
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yi Chen
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Jing Huang
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| | - Dong Sun
- Department of Geratology, General Hospital of Southern Theater Command, Guangzhou, China
| |
Collapse
|
10
|
Yi X, Jin D, Huang S, Xie Z, Zheng M, Zhou F, Jin Y. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with sepsis-associated liver injury: a retrospective cohort study. BMC Infect Dis 2024; 24:65. [PMID: 38195421 PMCID: PMC10775525 DOI: 10.1186/s12879-024-08978-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 01/02/2024] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The mortality rate of sepsis-associated liver injury (SALI) is relatively high, but there is currently no authoritative prognostic criterion for the outcome of SALI. Meanwhile, lactate-to-albumin ratio (LAR) has been confirmed to be associated with mortality rates in conditions such as sepsis, heart failure, and respiratory failure. However, there is a scarcity of research reporting on the association between LAR and SALI. This study aimed to elucidate the association between LAR and the 28-day mortality rate of SALI. METHODS In this retrospective cohort study, data were obtained from the Medical Information Mart for Intensive Care IV (v2.2). Adult patients with SALI were admitted to the intensive care unit in this study. The LAR level at admission was included, and the primary aim was to assess the relationship between the LAR and 28-day all-cause mortality. RESULTS A total of 341 patients with SALI (SALI) were screened. They were divided into a survival group (241) and a non-survival group (100), and the 28-day mortality rate was 29.3%. Multivariable Cox regression analysis revealed that for every 1-unit increase in LAR, the 28-day mortality risk for SALI patients increased by 21%, with an HR of 1.21 (95% CI 1.11 ~ 1.31, p < 0.001). CONCLUSIONS This study indicates that in patients with SALI, a higher LAR is associated with an increased risk of all-cause mortality within 28 days of admission. This suggests that LAR may serve as an independent risk factor for adverse outcomes in SALI patients.
Collapse
Affiliation(s)
- Xiaona Yi
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Dongcai Jin
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Shanshan Huang
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Zhenye Xie
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Meixia Zheng
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Fen Zhou
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China
| | - Yuhong Jin
- Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, China.
| |
Collapse
|
11
|
Chen Y, Lai W, Yang K, Wu B, Xie D, Peng C. Association between lactate/albumin ratio and prognosis in patients with acute myocardial infarction. Eur J Clin Invest 2024; 54:e14094. [PMID: 37725487 DOI: 10.1111/eci.14094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/23/2023] [Accepted: 08/26/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The association between the lactate/albumin ratio (L/A) as a diagnostic indicator and unfavourable clinical outcomes has been established in patients with community-acquired pneumonia, sepsis and heart failure, but the connection between L/A and all-cause mortality in patients with acute myocardial infarction (AMI) has yet to be fully understood. METHODS This was a retrospective cohort study using MIMIC-IV (v2.2) data, with 2816 patients enrolled and all-cause mortality during hospitalization as the primary outcome. Kaplan-Meier (KM) analysis was used to compare the all-cause mortality between high-level and low-level L/A groups. Receiver operating characteristic (ROC) curve, Restricted cubic splines (RCS) and Cox proportional hazards analysis were performed to investigate the relationship between L/A ratio and in-hospital all-cause mortality. RESULTS L/A values were significantly higher in the non-survivor groups than the survival groups (1.14 [.20] vs. .60 [.36], p < .05), and area under the ROC curve [.734 (95% confidence interval, .694-.775)] was better than other indicators. Data of COX regression analysis showed that higher L/A value supposed to be an independent risk factor for in-hospital mortality. RCS analysis showed evidence of an increasing trend and a non-linear relationship between L/A and in-hospital mortality (p-value was non-linear <.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (p < .001), and the former group had an increased risk of in-hospital mortality compared with the latter one (Log Rank p < .001). CONCLUSIONS L/A demonstrates significant independent predictive power for elevated all-cause mortality during hospitalization in patients diagnosed with AMI.
Collapse
Affiliation(s)
- Yang Chen
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiyan Lai
- Department of Nephrology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ke Yang
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bingyuan Wu
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongmei Xie
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chaoquan Peng
- Department of Cardiology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
12
|
Li T, Li X, Zhu Z, Liu X, Dong G, Xu Z, Zhang M, Zhou Y, Yang J, Yang J, Fang P, Qiao X. Clinical value of procalcitonin-to-albumin ratio for identifying sepsis in neonates with pneumonia. Ann Med 2023; 55:920-925. [PMID: 36908271 PMCID: PMC10795557 DOI: 10.1080/07853890.2023.2185673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 02/23/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND It is possible that neonates with pneumonia also have unrecognized sepsis. Identifying sepsis in neonates with pneumonia may cause some trouble for clinicians. This study aimed to evaluate the clinical value of the procalcitonin-to-albumin ratio (PAR) in identifying sepsis in neonates with pneumonia. METHODS We retrospectively included 912 neonates with pneumonia from January 2016 to July 2021. Clinical and laboratory data were collected from electronic medical records. Among neonates with pneumonia, 561 neonates were diagnosed with sepsis, according to the International Pediatric Sepsis Consensus. Neonates were divided into a sepsis group and a pneumonia group. A multivariate logistic regression analysis was used to evaluate whether PAR was a potential independent indicator for identifying sepsis in neonates with pneumonia. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic value of PAR in sepsis. RESULTS Neonates with sepsis have a higher PAR (p < 0.001). Correlation analysis showed that PAR was positively correlated with the level of C-reactive protein (r = 0.446, p < 0.001). Multiple logistic regression analysis showed that PAR was an independent predictor of the presence of sepsis in neonates with pneumonia. ROC curve analysis revealed that PAR had good power in identifying sepsis in neonates with pneumonia (area under curve (AUC) = 0.72, 95% confidence interval (CI), 0.68-0.75, p < 0.001). CONCLUSION PAR can be used as a new biomarker to identify sepsis in neonates with pneumonia.
Collapse
Affiliation(s)
- Tiewei Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
- The Center of Henan Children’s Neurodevelopmental Engineering Research, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Xiaojuan Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Zhiwei Zhu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Xinrui Liu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Geng Dong
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Min Zhang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Ying Zhou
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Jianwei Yang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Panpan Fang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, P.R. China
| | - Xiaoliang Qiao
- Center of Laboratory Medicine, Women & Infants Hospital of Zhengzhou, Zhengzhou, P.R. China
| |
Collapse
|
13
|
Turcato G, Zaboli A, Sibilio S, Rella E, Bonora A, Brigo F. Albumin as a prognostic marker of 30-day mortality in septic patients admitted to the emergency department. Intern Emerg Med 2023; 18:2407-2417. [PMID: 37563529 DOI: 10.1007/s11739-023-03387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Assessing the evolutive risk of septic patients in the emergency department (ED) is very complex. Predictive tools are available, but at an early stage, none of them can detect the tissue microvascular alterations underlying the septic process. Hypoalbuminemia is present in critically ill patients in the ICU, and some early indications also suggest its early role in septic patients. AIM To investigate the role of serum albumin concentration in predicting 30-day mortality among patients with sepsis at their first evaluation in the ED. METHODS Prospective observational study enrolling all patients with sepsis evaluated consecutively at the ED of the Merano Hospital from January to December 2021. The serum albumin concentration on admission was measured immediately upon patient arrival. A multivariate logistic regression model adjusted for possible confounders assessed the association between albumin levels at admission and 30-day mortality. Kaplan-Meier survival analysis was used to evaluate 30-day mortality between groups, and receiver operating characteristic (ROC) curve analysis was used to assess the discriminatory ability of albumin in predicting mortality. RESULTS 459 patients with community-acquired sepsis were included. 17% (78/459) of patients died within 30 days. In surviving patients, the mean albumin level was 3.6 g/dL (SD 0.5), while among non-survivors it was 3.1 g/dL (SD 0.4), p < 0.001. The area under the ROC was 0.754 (95% CI 0.701-0.807). Multivariate analysis found that albumin was an independent risk factor for 30-day mortality, with an adjusted risk ratio of 2.991 (95% CI 1.619-5.525, p < 0.001) for each 1 g/dL decrease in albumin. CONCLUSIONS Serum albumin concentration measured during initial ED assessment can be a useful prognostic marker of 30-day mortality in septic patients.
Collapse
Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Via Garziere, 43, 36014, Santorso, Italy.
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Eleonora Rella
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Antonio Bonora
- Emergency Department, University of Verona, Verona, Italy
| | - Francesco Brigo
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
| |
Collapse
|
14
|
Yin L, Min J, Zhong L, Shen Q. The correlation between red cell distribution width to albumin ratio and all-cause mortality in critically ill patients with rheumatic diseases: a population-based retrospective study. Front Med (Lausanne) 2023; 10:1199861. [PMID: 37908850 PMCID: PMC10614050 DOI: 10.3389/fmed.2023.1199861] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Patients with rheumatic diseases have an increased likelihood of being admitted to the intensive care unit (ICU), highlighting the importance of promptly identifying high-risk individuals to enhance prognosis. This study aimed to assess the correlation of red blood cell distribution width to albumin ratio (RAR) with the 90-days and 360-days survival rates among critically ill rheumatic patients. Methods Adult rheumatic patients admitted to the ICU from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database were included. The participants were categorized into two groups, survivors (n = 436) and non-survivors (n = 192), based on their 90-days survival outcome. The population was further classified into tertiles using RAR values, with RAR < 4.63 (n = 208), 4.63-6.07 (n = 211), and > 6.07 (n = 209). Kaplan-Meier curves were utilized to evaluate the cumulative survival rates at 90-days and 360-days. The association between RAR and mortality was assessed using restricted cubic splines (RCS) and multivariate Cox regression analysis. Additional subgroup analyses and sensitivity analyses were conducted to further explore the findings. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of RAR. Results This study involved 628 critically ill patients with rheumatic diseases, and they had an all-cause mortality of 30.57% at 90-days and 38.69% at 360-days. Kaplan-Meier analysis showed a gradual decrease in both 90-days and 360-days cumulative survival with increasing RAR (χ2 = 24.400, p < 0.001; χ2 = 35.360, p < 0.001). RCS revealed that RAR was linearly related to 90-days and 360-days all-cause mortality risk for critically ill patients with rheumatic diseases (χ2 = 4.360, p = 0.225; χ2 = 1.900, p = 0.594). Cox regression analysis indicated that elevated RAR (> 6.07) was significantly correlated with mortality. The ROC curves demonstrated that an optimal cut-off value of RAR for predicting 90-days mortality was determined to be 5.453, yielding a sensitivity of 61.5% and specificity of 60.3%. Conclusion Elevated RAR (> 6.07) was associated with all-cause mortality at 90-days and 360-days among critically ill patients with rheumatic diseases, serving as an independent risk factor for unfavorable prognosis.
Collapse
Affiliation(s)
- Lijuan Yin
- Department of Rheumatology, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, China
| | - Jie Min
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, China
| | - Qikai Shen
- Department of Intensive Care Unit, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, Huzhou, Zhejiang, China
- Affiliated Huzhou Hospital, Zhejiang University School of Medicine, Huzhou, China
- The Fifth School of Clinical Medicine, Zhejiang Chinese Medical University, Huzhou, China
| |
Collapse
|
15
|
Liu F, Liu Z. Association between ferritin to albumin ratio and 28-day mortality in patients with sepsis: a retrospective cohort study. Eur J Med Res 2023; 28:414. [PMID: 37817258 PMCID: PMC10563292 DOI: 10.1186/s40001-023-01405-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/28/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES The ratio of ferritin to albumin (FAR) has been proposed as a novel prognostic indicator for COVID-19. However, the role of FAR in predicting the all-cause mortality rate in patients with sepsis has not been evaluated. Therefore, the aim of this study is to elucidate the correlation between FAR and the 28-day all-cause mortality rate in patients with sepsis. METHODS This study used data from the Medical Information Mart for Intensive Care IV database (v2.0) for a retrospective cohort analysis. The study focused on adult patients with sepsis who were admitted to the intensive care unit. The primary objective was to assess the predictive capability of FAR in determining the 28-day all-cause mortality rate among patients with sepsis. RESULTS The study involved 1553 sepsis patients in total. Based on the survival status of sepsis patients within 28 days, they were divided into two groups: a survival group consisting of 973 patients, and a death group consisting of 580 patients. The results revealed a 28-day mortality rate of 37.35% among sepsis patients. The multivariable Cox regression analysis revealed that FAR was an independent predictor of the 28-day all-cause mortality rate in patients with sepsis (hazard ratio [HR]: 1.17-1.19; 95% confidence interval 1.11-1.26; P < 0.001). The FAR demonstrated a higher area under the curve (AUC) of 61.01% (95% confidence interval 58.07-63.96%), compared to serum ferritin (60.48%), serum albumin (55.56%), and SOFA score (56.97%). Receiver operating characteristic curve (ROC) analysis determined the optimal cutoff value for FAR as 364.2215. Kaplan-Meier analysis revealed a significant difference in the 28-day all-cause mortality rate between patients with FAR ≥ 364.2215 and those with FAR < 364.2215 (P < 0.001). Furthermore, subgroup analysis showed no significant interaction between FAR and each subgroup. CONCLUSIONS This study revealed a significant correlation between FAR and the 28-day mortality rate in patients with sepsis. Higher FAR values were strongly associated with increased mortality rates within 28 days.
Collapse
Affiliation(s)
- Feng Liu
- Ganzhou Maternal and Child Care Service Center, Ganzhou, Jiangxi, China
| | - Zhengting Liu
- Department of Clinical Laboratory, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou, Jiangxi, China.
| |
Collapse
|
16
|
Klinkmann G, Waterstradt K, Klammt S, Schnurr K, Schewe JC, Wasserkort R, Mitzner S. Exploring Albumin Functionality Assays: A Pilot Study on Sepsis Evaluation in Intensive Care Medicine. Int J Mol Sci 2023; 24:12551. [PMID: 37628734 PMCID: PMC10454468 DOI: 10.3390/ijms241612551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/27/2023] Open
Abstract
Human serum albumin (HSA) as the most abundant plasma protein carries multifunctional properties. A major determinant of the efficacy of albumin relies on its potent binding capacity for toxins and pharmaceutical agents. Albumin binding is impaired in pathological conditions, affecting its function as a molecular scavenger. Limited knowledge is available on the functional properties of albumin in critically ill patients with sepsis or septic shock. A prospective, non-interventional clinical trial assessed blood samples from 26 intensive care patients. Albumin-binding capacity (ABiC) was determined by quantifying the unbound fraction of the fluorescent marker, dansyl sarcosine. Electron paramagnetic resonance fatty acid spin-probe evaluated albumin's binding and detoxification efficiencies. Binding efficiency (BE) reflects the strength and amount of bound fatty acids, and detoxification efficiency (DTE) indicates the molecular flexibility of patient albumin. ABiC, BE, and DTE effectively differentiated control patients from those with sepsis or septic shock (AUROC > 0.8). The diagnostic performance of BE showed similarities to procalcitonin. Albumin functionality correlates with parameters for inflammation, hepatic, or renal insufficiency. Albumin-binding function was significantly reduced in critically ill patients with sepsis or septic shock. These findings may help develop patient-specific algorithms for new diagnostic and therapeutic approaches.
Collapse
Affiliation(s)
- Gerd Klinkmann
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, 18057 Rostock, Germany
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
| | - Katja Waterstradt
- Department of Research and Development, MedInnovation GmbH, 12487 Berlin, Germany
| | - Sebastian Klammt
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Kerstin Schnurr
- Department of Research and Development, MedInnovation GmbH, 12487 Berlin, Germany
| | - Jens-Christian Schewe
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Medical Center Rostock, Schillingallee 35, 18057 Rostock, Germany
| | - Reinhold Wasserkort
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| | - Steffen Mitzner
- Fraunhofer Institute for Cell Therapy and Immunology, Department of Extracorporeal Therapy Systems, Schillingallee 68, 18057 Rostock, Germany
- Division of Nephrology, Department of Internal Medicine, University Medical Center Rostock, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
| |
Collapse
|
17
|
Shi J, Lu ZQ, Lin QM, Zeng W, Gu PJ, Yu Q, Long J, Huang DG, Dai YH. The Role of Albumin in the Diagnosis of Neonatal Sepsis Over the Last 11 Years: A Retrospective Study. J Inflamm Res 2023; 16:2855-2863. [PMID: 37489147 PMCID: PMC10363390 DOI: 10.2147/jir.s414611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
Background There are many difficulties and uncertainties in the early diagnosis of neonatal sepsis. The aim of this study was to determine whether albumin (ALB) is useful for the early diagnosis of neonatal sepsis using ALB, C-reactive protein (CRP) and procalcitonin (PCT) together. Methods ALB, CRP, PCT and white blood cell (WBC) data from 732 patients with neonatal sepsis and 1317 neonatal infection patients hospitalized in Foshan Maternal and Child Health Hospital from 2011 to 2022 were collected. Receiver operating characteristic (ROC) and logistic regression analyses were performed to assess the diagnostic value of ALB, CRP, PCT and the WBC count for neonatal sepsis. The roles of ALB, CRP, PCT and the WBC count in the diagnosis of neonatal sepsis were analysed by using subject working characteristics (ROC) and areas under the curve (AUCs), and the variables were combined to determine which combination had the best diagnostic efficacy. Results In the sepsis group, the ALB, CRP, and PCT levels and the WBC count were significantly higher than those in the infection group (P<0.001). In all infants, the sensitivities and specificities of ALB, CRP, PCT, and WBC count were 0.411, 0.596, 0.483 and 0.411, respectively, and 0.833, 0.846, 0.901 and 0.796, respectively. With a sensitivity of 0.646, a specificity of 0.929, and an AUC of 0.834, the best combination was that of ALB, CRP, and PCT, which was better than that of CRP + PCT, CRP + ALB and PCT + ALB. Conclusion In neonatal sepsis, in the absence of blood culture results, the combination of ALB, CRP, and PCT is more reliable than CRP, PCT, or CRP+PCT alone. These results suggest that ALB is a useful inflammatory biomarker for the early diagnosis of neonatal sepsis, and can improve the diagnostic efficiency.
Collapse
Affiliation(s)
- Jipeng Shi
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Zhen-Qi Lu
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Qing-Mei Lin
- Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Wang Zeng
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Ping-Jiao Gu
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Qing Yu
- Department of Clinical Laboratory, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Jing Long
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Da-Gui Huang
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| | - Yi-Heng Dai
- Department of Neonatal, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University (Foshan Maternity & Child Healthcare Hospital), Foshan, Guangdong, 528000, People’s Republic of China
| |
Collapse
|
18
|
Gray K, Engoren M. Outcomes of Sepsis in Patients With and Without HIV Infection: A Retrospective Study. Am J Crit Care 2023; 32:288-293. [PMID: 37391374 DOI: 10.4037/ajcc2023446] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
BACKGROUND HIV infection is associated with increased infections. OBJECTIVES To (1) compare patients with sepsis with and without HIV, (2) assess whether HIV is associated with mortality in sepsis, and (3) identify factors associated with mortality in patients with HIV and sepsis. METHODS Patients who met Sepsis-3 criteria were studied. HIV infection was defined as administration of highly active antiretroviral therapy, a diagnosis of AIDS encoded by the International Classification of Diseases, or a positive HIV blood test result. Propensity scores were used to match patients with HIV to similar patients without HIV, and mortality was compared with χ2 tests. Logistic regression was used to determine factors independently associated with mortality. RESULTS Sepsis developed in 34 673 patients without HIV and 326 patients with HIV. Of these, 323 (99%) patients with HIV were matched to similar patients without HIV. The 30-60- and 90-day mortality was 11%, 15%, and 17%, respectively, in patients with sepsis and HIV, which was similar to the 11% (P > .99), 15% (P > .99), and 16% (P = .83) in patients without HIV. Logistic regression to adjust for confounders showed that obesity (odds ratio, 0.12; 95% CI, 0.03-0.46; P = .002) and high total protein on admission (odds ratio, 0.71; 95% CI, 0.56-0.91; P = .007) were associated with lower mortality. Mechanical ventilation at sepsis onset, renal replacement therapy, positive blood culture, and platelet transfusion were associated with increased mortality. CONCLUSIONS HIV infection was not associated with increased mortality in patients with sepsis.
Collapse
Affiliation(s)
- Kevin Gray
- Kevin Gray is a resident physician, Department of Anesthesiology, The Ohio State University, Columbus, Ohio
| | - Milo Engoren
- Milo Engoren is a clinical professor, Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
19
|
Turcato G, Zaboli A, Sibilio S, Fanni Canelles M, Rella E, Giudiceandrea A, Pfeifer N, Brigo F. Prognostic Role of Serum Albumin in Predicting 30-Day Mortality in Patients with Infections in Emergency Department: A Prospective Study. J Clin Med 2023; 12:jcm12103447. [PMID: 37240554 DOI: 10.3390/jcm12103447] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/08/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Infections in emergency departments (EDs) are insidious clinical conditions characterised by high rates of hospitalisation and mortality in the short-to-medium term. The serum albumin, recently demonstrated as a prognostic biomarker in septic patients in intensive care units, could be an early marker of severity upon arrival of infected patients in the ED. AIM To confirm the possible prognostic role of the albumin concentration recorded upon arrival of patients with infection. METHODS A prospective single-centre study was performed in the ED of the General Hospital of Merano, Italy, between 1 January 2021 and 31 December 2021. All enrolled patients with infection were tested for serum albumin concentration. The primary outcome measure was 30-day mortality. The predictive role of albumin was assessed by logistic regression and decision tree analysis adjusted for Charlson comorbidity index, national early warning score, and sequential organ failure assessment (SOFA) score. RESULTS 962 patients with confirmed infection were enrolled. The median SOFA score was 1 (0-3) and the mean serum albumin level was 3.7 g/dL (SD 0.6). Moreover, 8.9% (86/962) of patients died within 30 days. Albumin was an independent risk factor for 30-day mortality with an adjusted hazard ratio of 3.767 (95% CI 2.192-6.437), p < 0.001. Decision tree analysis indicated that at low SOFA scores, albumin had a good predictive ability, indicating a progressive mortality risk reduction in concentrations above 2.75 g/dL (5.2%) and 3.52 g/dL (2%). CONCLUSIONS Serum albumin levels at ED admission are predictive of 30-day mortality in infected patients, showing better predictive abilities in patients with low-to-medium SOFA scores.
Collapse
Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), 36014 Santorso, Italy
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Massimiliano Fanni Canelles
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Eleonora Rella
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Alberto Giudiceandrea
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Norbert Pfeifer
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
| | - Francesco Brigo
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, 5020 Salzburg, Austria
- Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), 39012 Merano-Meran, Italy
| |
Collapse
|
20
|
Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, Brück LM, Hoffmann U, Bertsch T, Müller J, Kittel M, Akin I, Behnes M. Diagnostic and Prognostic Performance of Plasma Albumin and Cholinesterase in Patients with Sepsis and Septic Shock. Med Princ Pract 2023; 32:133-142. [PMID: 37068474 PMCID: PMC10319091 DOI: 10.1159/000530631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/05/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVE Despite improved risk stratification tools and identification of novel biomarkers for the diagnosis and prognosis in patients with sepsis, sepsis-related mortality has not significantly improved during the past years. This study investigates the diagnostic and prognostic role of the plasma albumin and cholinesterase (ChE) in patients with sepsis and septic shock. METHODS Consecutive patients with sepsis and septic shock from 2019 to 2021 were included at one institution. Blood samples were obtained on the day of disease onset (day 1), and on days 2, 3, 5, and 7 thereafter. The diagnostic value of ChE for the diagnosis of a septic shock was compared to albumin and the prognostic value of the albumin and the ChE for 30-day all-cause mortality was tested. RESULTS 239 patients were included with a median albumin level of 21.4 g/dL and a median ChE of 5004 U/L on admission. With an area under the curve (AUC) of 0.641-0.762 on days 3 and 5, the ChE was associated with moderate but better diagnostic discrimination between sepsis and septic shock than albumin. Furthermore, ChE was able to discriminate between 30-day non-survivors and survivors (range of AUC 0.612-0.686). Patients with a ChE below the median had higher rates of 30-days all-cause mortality in comparison to patients with a ChE above the median (65 vs. 42%, log rank p = 0.001; HR = 1.820; 95% CI = 1.273-2.601; p = 0.001), which was still demonstrated after multivariable adjustment. CONCLUSION The level of ChE was associated with moderate diagnostic and prognostic accuracy in patients with sepsis and septic shock, whereas albumin was not.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Schanas Jawhar
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Floriana Dulatahu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Lea Marie Brück
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, Bad Neustadt a. d. Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, Marburg, Germany
| | - Maximilian Kittel
- Institute for Clinical Chemistry, Faculty of Medicine Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, Mannheim, Germany
| |
Collapse
|
21
|
Schupp T, Behnes M, Rusnak J, Ruka M, Dudda J, Forner J, Egner-Walter S, Barre M, Abumayyaleh M, Bertsch T, Müller J, Akin I. Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock? Int J Mol Sci 2023; 24:ijms24087375. [PMID: 37108536 PMCID: PMC10138505 DOI: 10.3390/ijms24087375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
This study investigates the prognostic impact of albumin levels in patients with cardiogenic shock (CS). Intensive care unit (ICU) related mortality in CS patients remains unacceptably high despite improvement concerning the treatment of CS patients. Limited data regarding the prognostic value of albumin in patients with CS is available. All consecutive patients with CS from 2019 to 2021 were included at one institution. Laboratory values were retrieved from the day of disease onset (day 1) and days 2, 3, 4, and 8 thereafter. The prognostic impact of albumin was tested for 30-day all-cause mortality. Moreover, the prognostic performance of albumin decline during ICU treatment was examined. Statistical analyses included univariable t-test, Spearman's correlation, Kaplan-Meier analyses, multivariable mixed analysis of variance (ANOVA), C-Statistics, and Cox proportional regression analyses. In total, 230 CS patients were included, with an overall all-cause mortality at 30 days of 54%. The median albumin on day 1 was 30.0 g/L. Albumin on day 1 was able to discriminate between 30-day survivors and non-survivors (area under the curve (AUC) 0.607; 0.535-0.680; p = 0.005). CS patients with albumin < 30.0 g/L were associated with an increased risk of 30-day all-cause mortality (63% vs. 46%; log-rank p = 0.016; HR = 1.517; 95% CI 1.063-2.164; p = 0.021), which was demonstrated even after multivariable adjustment. Moreover, a decrease of albumin levels by ≥20% from day 1 to day 3 was accompanied by a higher risk of 30-days all-cause mortality (56% vs. 39%; log-rank p = 0.036; HR = 1.645; 95% CI 1.014-2.669; p = 0.044). Especially when combined with lactate, creatinine, and cardiac troponin I, reliable discrimination of 30-day all-cause mortality was observed, including albumin in CS risk stratification models (AUC = 0.745; 95% CI 0.677-0.814; p = 0.001). In conclusion, low baseline albumin levels as well as a decay of albumin levels during the course of ICU treatment, deteriorate prognostic outcomes in CS patients. The additional assessment of albumin levels may further improve risk stratification in CS patients.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Marinela Ruka
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jonas Dudda
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Sascha Egner-Walter
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Max Barre
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Mohammad Abumayyaleh
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Julian Müller
- Clinic for Interventional Electrophysiology, Heart Centre Bad Neustadt, 97616 Bad Neustadt a. d. Saale, Germany
- Department of Cardiology and Angiology, Philipps-University Marburg, 35037 Marburg, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, 69117 Heidelberg, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/Mannheim, 68167 Mannheim, Germany
| |
Collapse
|
22
|
Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, Brück LM, Lübke J, Hoffmann U, Bertsch T, Behnes M, Akin I. Fibrinogen reflects severity and predicts outcomes in patients with sepsis and septic shock. Blood Coagul Fibrinolysis 2023; 34:161-170. [PMID: 36966770 DOI: 10.1097/mbc.0000000000001197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
The study investigates the diagnostic and prognostic value of fibrinogen and the albumin-to-fibrinogen-ratio (AFR) in patients with sepsis and septic shock. Limited data regarding the prognostic value of fibrinogen and AFR during the course of sepsis or septic shock are available. Consecutive patients with sepsis and septic shock from 2019 to 2021 were included monocentrically. Blood samples were retrieved from the day of disease onset (day 1), as well as on day 2 and 3. Firstly, the diagnostic value of fibrinogen and the AFR for the diagnosis of a septic shock was tested. Secondly, the prognostic value of fibrinogen and AFR was tested with regard to the 30-day all-cause mortality. Statistical analyses included univariable t-tests, Spearman's correlations, C-statistics, Kaplan-Meier and multivariable Cox regression analyses. Ninety-one patients with sepsis and septic shock were included. With an area under the curve (AUC) of 0.653-0.801, fibrinogen discriminated patients with septic shock from those with sepsis. In the septic shock group, fibrinogen levels were shown to decrease from day 1 to 3 (median decrease 41%). In line, fibrinogen was a reliable predictor for 30-day all-cause mortality (AUC 0.661-0.744), whereas fibrinogen levels less than 3.6 g/l were associated with an increased risk of 30-day all-cause mortality (78 vs. 53%; log rank P = 0.004; hazard ratio = 2.073; 95% confidence interval 1.233-3.486; P = 0.006), which was still observed after multivariable adjustment. In contrast, the AFR was no longer associated with the risk of mortality after multivariable adjustment. Fibrinogen was a reliable diagnostic and prognostic tool for the diagnosis of septic shock as well as for 30-day all-cause mortality and superior compared with the AFR in patients admitted with sepsis or septic shock.
Collapse
Affiliation(s)
- Tobias Schupp
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Kathrin Weidner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Jonas Rusnak
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Schanas Jawhar
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Jan Forner
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Floriana Dulatahu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Lea Marie Brück
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Johannes Lübke
- Third Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim
| | - Ursula Hoffmann
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Thomas Bertsch
- Institute of Clinical Chemistry, Laboratory Medicine and Transfusion Medicine, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Michael Behnes
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim
| |
Collapse
|
23
|
İLBAN Ö. Nutritional indices may have prognostic value in elderly critically ill patients with sepsis. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1217406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Aim: Nutritional indicators are associated with adverse outcomes in critically ill elderly patients. In this study, we aimed to evaluate the prognostic potential of prealbumin and albumin in the prediction of mortality in elderly patients with sepsis.
Material and Method: A total of 108 patients who developed intensive care unit-acquired sepsis were divided into two groups: Survivors (n=72) and Non-survivors (n=36).
Results: Patients in the Non-survivors group were often older (68 vs 74) and presented lower prealbumin (15.1 vs 11), and higher Charlson index (4 vs 6), Sequential Organ Failure Assessment (SOFA) score (8.5 vs 10), C-reactive protein (CRP) (68.8 vs 91) and procalcitonin (PCT) (6 vs 8.4) (p< 0.05). The area under the curve of PCT was the highest at 0.74. Prealbumin presented the best sensitivity (75%) and 12 mg/dL cut-off value, while PCT had the best specificity (75%) and a cut-off value of 7 ng/mL. Although prealbumin was negatively correlated to SOFA score in a significant way (r=-0.226, p=0.019), White blood cells, CRP, and PCT were positively correlated to SOFA score (r=0.198, p=0.040; r=0.233, p=0.015; r=0.286, p=0.003, respectively). In addition, a weak negative correlation was observed between prealbumin and CRP and PCT (r=-0.203, p=0.037; r=-0.215, p=0.026, respectively). Multivariate analysis showed that a reduction in serum prealbumin levels compared to steady prealbumin greater than 4 mg/dL increased the risk of death by 85% (aHR: 1.85, 95% CI: 1.05-2.56, p=0.029).
Conclusion: Changes in serum prealbumin in the acute phase of sepsis may assist in determining the risk of mortality and in the administration of specific treatment in critically ill elderly patients.
Collapse
|
24
|
Cao Y, Su Y, Guo C, He L, Ding N. Albumin Level is Associated with Short-Term and Long-Term Outcomes in Sepsis Patients Admitted in the ICU: A Large Public Database Retrospective Research. Clin Epidemiol 2023; 15:263-273. [PMID: 36895828 PMCID: PMC9990453 DOI: 10.2147/clep.s396247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/20/2023] [Indexed: 03/06/2023] Open
Abstract
Objective This study aimed to explore the relationship between albumin level with short- and long-term outcomes in sepsis patients admitted in the intensive care unit (ICU) based on a large public database to provide clinical evidence for physicians to make individualized plans of albumin supplementation. Methods Sepsis patients admitted in the ICU in MIMIC-IV were included. Different models were performed to investigate the relationships between albumin and mortalities of 28-day, 60-day, 180-day and 1-year. Smooth fitting curves were performed. Results A total of 5357 sepsis patients were included. Mortalities of 28-day, 60-day, 180-day and 1-year were 29.29% (n = 1569), 33.92% (n = 1817), 36.70% (n = 1966) and 37.71% (n = 2020). In the fully adjusted model (adjusted for all potential confounders), with each 1g/dL increment in albumin level, the risk of mortality in 28-day, 60-day, 180-day and 1-year decreased by 39% (OR = 0.61, 95% CI: 0.54-0.69), 34% (OR = 0.66, 95% CI: 0.59-0.73), 33% (OR = 0.67, 95% CI: 0.60-0.75), and 32% (OR = 0.68, 95% CI: 0.61-0.76), respectively. The non-linear negative relationships between albumin and clinical outcomes were confirmed by smooth fitting curves. The turning point of albumin level was 2.6g/dL for short- and long-term clinical outcomes. When albumin level ≤2.6g/dL, with each 1g/dL increment in albumin level, the risk of mortality in 28-day, 60-day, 180-day and 1-year decreased by 59% (OR = 0.41, 95% CI: 0.32-0.52), 62% (OR = 0.38, 95% CI: 0.30-0.48), 65% (OR = 0.35, 95% CI: 0.28-0.45), and 62% (OR = 0.38, 95% CI: 0.29-0.48), respectively. Conclusion Albumin level was associated with short- and long-term outcomes in sepsis. Albumin supplementation might be beneficial for septic patients with serum albumin<2.6g/dL.
Collapse
Affiliation(s)
- Yan Cao
- Department of Emergency Medicine, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan Province, People's Republic of China
| | - Yingjie Su
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan Province, People's Republic of China
| | - Cuirong Guo
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan Province, People's Republic of China
| | - Liudang He
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan Province, People's Republic of China
| | - Ning Ding
- Department of Emergency Medicine, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, Hunan Province, People's Republic of China
| |
Collapse
|
25
|
Atamna A, Margalit I, Ayada G, Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Fattah MA, Haquin J, Macgowan A, Chazan B, Yanovskay A, Ami RB, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Rodríguez-Baño J, de Cueto M, Oliver A, de Gopegui ER, Cano A, Machuca I, Gozalo-Marguello M, Martinez-Martinez L, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstei Y, Yahav D. Outcomes of octogenarians and nonagenarians with Pseudomonas aeruginosa bacteremia: a multicenter retrospective study. Infection 2022:10.1007/s15010-022-01973-x. [PMID: 36571672 DOI: 10.1007/s15010-022-01973-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND P. aeruginosa bacteremia is a common and severe infection carrying high mortality in older adults. We aimed to evaluate outcomes of P. aeruginosa bacteremia among old adults (≥ 80 years). METHODS We included the 464/2394 (19%) older adults from a retrospective multinational (9 countries, 25 centers) cohort study of individuals hospitalized with P. aeruginosa bacteremia. Bivariate and multivariable logistic regression models were used to evaluate risk factors for 30-day mortality among older adults. RESULTS Among 464 adults aged ≥ 80 years, the mean age was 84.61 (SD 3.98) years, and 274 (59%) were men. Compared to younger patients, ≥ 80 years adults had lower Charlson score; were less likely to have nosocomial acquisition; and more likely to have urinary source. Thirty-day mortality was 30%, versus 27% among patients 65-79 years (n = 894) and 25% among patients < 65 years (n = 1036). Multivariate analysis for predictors of mortality among patients ≥ 80 years, demonstrated higher SOFA score (odds ratio [OR] 1.36, 95% confidence interval [CI] 1.23-1.51, p < 0.001), corticosteroid therapy (OR 3.15, 95% CI: 1.24-8.01, p = 0.016) and hospital acquired P. aeruginosa bacteremia (OR 2.30, 95% CI: 1.33-3.98, p = 0.003) as predictors. Appropriate empirical therapy within 24 h, type of definitive anti-pseudomonal drug, and type of regimen (monotherapy or combination) were not associated with 30-day mortality. CONCLUSIONS In older adults with P. aeruginosa bacteremia, background conditions, place of acquisition, and disease severity are associated with mortality, rather than the antimicrobial regimen. In this regard, preventive efforts and early diagnosis before organ failure develops might be beneficial for improving outcomes.
Collapse
Affiliation(s)
- Alaa Atamna
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel. .,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Ili Margalit
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel.,Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gida Ayada
- Medicine C, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Tanya Babich
- Infectious Diseases Unit, Rain Medical Center, Beilinson Hospital, 39 Jabotinsky Road, Petah Tikva, Israel.,Research Authority, Rabin Medical Center, Beilinson Hospital, Petah-Tikva, Israel
| | - Pontus Naucler
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Christian G Giske
- Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Natividad Benito
- Infectious Diseases Unit, Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruben Cardona
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Alba Rivera
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau-Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Celine Pulcini
- Université de Lorraine, APEMAC, 54000, Nancy, France.,Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Manal Abdel Fattah
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Justine Haquin
- Infectious Diseases Department, Université de Lorraine, CHRU-Nancy, 54000, Nancy, France
| | - Alasdair Macgowan
- Department of Infection Sciences, Pathology Sciences Building, Southmead Hospital, Bristol, UK
| | - Bibiana Chazan
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Anna Yanovskay
- Infectious Diseases Unit, Emek Medical Center, Afula, Israel.,Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Ronen Ben Ami
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Michal Landes
- Infectious Diseases Unit, Sourasky Medical Center, Tel-Aviv, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Adi Zaidman-Shimshovitz
- Infectious Disease Institute, Soroka Medical Center, Ben-Gurion University of the Negev, Beer Sheba, Israel
| | - Kate McCarthy
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - David L Paterson
- UQ Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Evelina Tacconelli
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Michael Buhl
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Susanna Mauer
- Division of Infectious Diseases, Tuebingen University Hospital, Tuebingen, Germany
| | - Jesús Rodríguez-Baño
- Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS)/CSIC and CIBERINFEC, Instituto de Salud Carlos III ES, Sevilla, Spain
| | - Marina de Cueto
- Hospital Universitario Virgen Macarena, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS)/CSIC and CIBERINFEC, Instituto de Salud Carlos III ES, Sevilla, Spain
| | - Antonio Oliver
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma, Spain
| | - Enrique Ruiz de Gopegui
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Illes Balears (IdISBa), Palma, Spain
| | - Angela Cano
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Isabel Machuca
- Infectious Diseases Unit, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Luis Martinez-Martinez
- Microbiology Service, University Hospital Marqués de Valdecilla-IDIVAL, Santander, Spain
| | | | | | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Bojana Beovic
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Andreja Saje
- Department of Infectious Diseases, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Manica Mueller-Premru
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Leonardo Pagani
- Infectious Diseases Unit, Bolzano Central Hospital, Bolzano, Italy
| | - Virginie Vitrat
- Infectious Diseases Unit, Annecy-Genevois Hospital Center (CHANGE), Annecy, France
| | - Diamantis Kofteridis
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Zacharioudaki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Sofia Maraki
- Infectious Disease Unit, Department of Internal Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Yulia Weissman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mical Paul
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Yaakov Dickstei
- Infectious Diseases Unit, Rambam Health Care Campus, Haifa, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Center, Ramat-Gan, Israel
| | | |
Collapse
|
26
|
Shokr H, Marwah MK, Siddiqi H, Wandroo F, Sanchez-Aranguren L, Ahmad S, Wang K, Marwah S. Lactate Dehydrogenase/Albumin To-Urea Ratio: A Novel Prognostic Maker for Fatal Clinical Complications in Patients with COVID-19 Infection. J Clin Med 2022; 12:jcm12010019. [PMID: 36614820 PMCID: PMC9821448 DOI: 10.3390/jcm12010019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Objective: To investigate lactate dehydrogenase/Albumin to-urea (LAU) ratio as a potential predictor for COVID-19-induced fatal clinical complications in hospitalized patients. Methods: This is a retrospective study involving blood analyses from 1139 hospitalised COVID-19 infection survivors and 349 deceased cases post-COVID-19 infection. Laboratory tests included complete blood picture, inflammatory markers, and routine organ function tests. Results: The non-survivor group showed lower haemoglobin (p < 0.001), platelet (p < 0.0001) and higher mean corpuscular volume, neutrophil count, neutrophil/lymphocytes ratio (NLR), and LAU (p < 0.001, p < 0.0013, p < 0.001, p < 0.0126) than the patients who survived the infection. The non-survivors also exhibited higher markers for infection-related clinical complications, such as international normalized ratio (INR), D-dimer, urea, total bilirubin, alkaline phosphatase (ALK), creatinine, c-reactive protein (CRP), and serum ferritin levels (all p < 0.05). In addition, LAU ratio was positively correlated with infection prognostic parameters including INR (r = 0.171), D-dimer (r = 0.176), serum urea (r = 0.424), total bilirubin (r = 0.107), ALK (r = 0.115), creatinine (r = 0.365), CRP (r = 0.268), ferritin (r = 0.385) and negatively correlated with serum albumin (r = −0.114) (p ≤ 0.05). LAU ratio had an area under receiver operating characteristic of 0.67 compared to 0.60 with NLR. Conclusion: Patients with a high LAU ratio are at increased risk of mortality due to COVID-19 infection. Therefore, early assessment of this parameter, intensive intervention and close monitoring could improve their prognosis.
Collapse
Affiliation(s)
- Hala Shokr
- Pharmacy Division, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
- Correspondence: (H.S.); (S.M.)
| | - Mandeep Kaur Marwah
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Hisam Siddiqi
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
| | - Farooq Wandroo
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
| | | | - Shakil Ahmad
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Keqing Wang
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
| | - Sukhjinder Marwah
- Department of Haematology, Sandwell and West, Birmingham Hospitals NHS Trust, West Bromwich B71 4HJ, UK
- Correspondence: (H.S.); (S.M.)
| |
Collapse
|
27
|
Interpretable Machine Learning to Optimize Early In-Hospital Mortality Prediction for Elderly Patients with Sepsis: A Discovery Study. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4820464. [PMID: 36570336 PMCID: PMC9779998 DOI: 10.1155/2022/4820464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/30/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
Sepsis-related mortality rates are high among elderly patients, especially those in intensive care units (ICUs). Early prediction of the prognosis of sepsis is critical, as prompt and effective treatment can improve prognosis. Researchers have predicted mortality and the development of sepsis using machine learning algorithms; however, few studies specifically focus on elderly patients with sepsis. This paper proposes a viable model for early prediction of in-hospital mortality among elderly patients diagnosed with sepsis. We extracted patient information from the Medical Information Mart for Intensive Care IV database. We employed several machine learning algorithms to predict the in-hospital mortality of elderly ICU patients with sepsis. The performance of the model was evaluated by using the AUROC and F1 score. Furthermore, the SHAP algorithm was used to explain the model, analyze how the individual features affect the model output, and visualize the Shapley value for a single individual. Our study included 18522 elderly patients, with a mortality of 15.4%. After screening, 59 clinical variables were extracted to develop models. Feature importance analysis showed that age, PO2, RDW, SPO2, WBC, and urine output were significantly related to the in-hospital mortality. According to the results of AUROC (0.871 (95% CI: 0.854-0.888)) and F1 score (0.547 (95% CI: 0.539-0.661)) analyses, the extreme gradient boosting (XGBoost) model outperformed the other models (i.e., LGBM, LR, RF, DT, and KNN). Furthermore, SHAP force analysis illustrated how the constructed model visualized the individualized prediction of death. XGBoost machine learning framework gives good in-hospital mortality prediction of elderly patients with sepsis and can maximize prediction model accuracy. The XGBoost model could be an effective tool to assist doctors in identifying high-risk cases of in-hospital mortality among elderly patients with sepsis. This could be used to create a clinical decision support system in the future.
Collapse
|
28
|
Liu Q, Zheng HL, Wu MM, Wang QZ, Yan SJ, Wang M, Yu JJ, Li DP. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database. Front Immunol 2022; 13:1076121. [PMID: 36591285 PMCID: PMC9795001 DOI: 10.3389/fimmu.2022.1076121] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The Lactate-to-Albumin Ratio (LAR) has been applied as a new predictor in sepsis, heart failure, and acute respiratory failure. However, the role of LAR in predicting all-cause mortality in patients with acute pancreatitis has not been evaluated. Therefore, this study aimed to elucidate the correlation between LAR and 28-d all-cause mortality in patients with Acute Pancreatitis (AP). Methods This study is a retrospective cohort study with the data from the MIMIC-IV (v1.0) database. We included adult patients with acute pancreatitis who were admitted to the intensive care unit in the study. The primary outcome was to evaluate the ability of LAR to predict death at 28-d of hospital admission in patients with AP. Results A total of 539 patients with acute pancreatitis were included in this study. They were divided into a survival group (486 patients) and a death group (53 patients) according to whether they survived within 28-d of admission, and the mortality rate of patients within 28-d of admission was 9.8%. LAR was shown to be an independent predictor of all-cause mortality within 28-d of admission in patients with AP by multivariate COX regression analysis (HR, 1.59; 95% CI, 1.23 - 2.05; P < 0.001). the Area Under the Curve (AUC) value for LAR was 74.26% (95% CI: 67.02% - 81.50%), which was higher than that for arterial blood lactate (AUC = 71.25%) and serum albumin (AUC = 65.92%) alone. It was not inferior even when compared to SOFA (AUC = 75.15%). The optimal cutoff value for separating the survival and death groups according to Receiver Operating Characteristic (ROC) was found to be 1.1124. plotting Kaplan-Meier analysis with this cutoff value showed that patients with LAR ≥ 1.1124 had significantly higher all-cause mortality within 28-d of admission than those with LAR < 1.1124 (P < 0.001). The final subgroup analysis showed no significant interaction of LAR with each subgroup (P for interaction: 0.06 - 0.974). Conclusion LAR can be used as an independent predictor of all-cause mortality in AP patients within 28-d of admission, with superior prognostic performance than arterial blood lactate or serum albumin alone.
Collapse
|
29
|
Machine Learning Model Development and Validation for Predicting Outcome in Stage 4 Solid Cancer Patients with Septic Shock Visiting the Emergency Department: A Multi-Center, Prospective Cohort Study. J Clin Med 2022; 11:jcm11237231. [PMID: 36498805 PMCID: PMC9737041 DOI: 10.3390/jcm11237231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
A reliable prognostic score for minimizing futile treatments in advanced cancer patients with septic shock is rare. A machine learning (ML) model to classify the risk of advanced cancer patients with septic shock is proposed and compared with the existing scoring systems. A multi-center, retrospective, observational study of the septic shock registry in patients with stage 4 cancer was divided into a training set and a test set in a 7:3 ratio. The primary outcome was 28-day mortality. The best ML model was determined using a stratified 10-fold cross-validation in the training set. A total of 897 patients were included, and the 28-day mortality was 26.4%. The best ML model in the training set was balanced random forest (BRF), with an area under the curve (AUC) of 0.821 to predict 28-day mortality. The AUC of the BRF to predict the 28-day mortality in the test set was 0.859. The AUC of the BRF was significantly higher than those of the Sequential Organ Failure Assessment score and the Acute Physiology and Chronic Health Evaluation II score (both p < 0.001). The ML model outperformed the existing scores for predicting 28-day mortality in stage 4 cancer patients with septic shock. However, further studies are needed to improve the prediction algorithm and to validate it in various countries. This model might support clinicians in real-time to adopt appropriate levels of care.
Collapse
|
30
|
Decreased circulating levels of free triiodothyronine in Sepsis children and correlation analysis. BMC Pediatr 2022; 22:687. [PMID: 36447149 PMCID: PMC9707259 DOI: 10.1186/s12887-022-03756-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 11/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Intensive physical stress in sepsis can induce the disorder of endocrine function and impact the clinical course and prognosis. Low T3 syndrome has been verified to be the predictive indicator of poor prognosis in several researches. Reports on the influence factors of thyroid hormonal levels in children with severe sepsis are rare. We aim to investigate the thyroid hormonal variations in the course of sepsis and analyze that how to be affected by clinical data and inflammatory biomarkers. METHODS In the case-control study, 184 children with sepsis and 323 controls were included in Tongji Hospital, Wuhan, China, in 2019. Data on clinical and inflammatory parameters were collected from all participants. Circulating FT3(Free Triiodothyronine) levels were measured by Electrochemiluminescence immunoassay. Finally, we investigated the correlation between FT3 and related variables with linear regression analysis. RESULTS Serum FT3 was lower in the sepsis group than in control group(2.59 + 1.17 vs 2.83 + 1.01 pg/mL, p < 0.05). Significant moderately negative correlations(|r| > 0.3) of FT3 levels with ferritin, PCT, duration of symptoms, SOFA score, and mortality were revealed. Moreover, we observed that FT3 had the positive correlation with albumin, as well as white blood cell count. CONCLUSIONS Concentrations of serum FT3 are dramatically declined in sepsis children than in control children. Our results demonstrate that recognizing the potential abnormality of thyroid hormones in sepsis patients and examine timely through abnormal common clinical data and inflammatory biomarkers is a fine option.
Collapse
|
31
|
Association between Early Phase Serum Albumin Levels and Outcomes of Post-Cardiac Arrest Patients: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12111787. [PMID: 36579497 PMCID: PMC9697792 DOI: 10.3390/jpm12111787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 01/01/2023] Open
Abstract
We aimed to evaluate early phase serum albumin levels in and outcomes of resuscitated patients after cardiac arrest. Medline, EMBASE, and the Cochrane Library were systematically searched until 4 July 2022, for studies on post-cardiac arrest patients and involving measurement of early phase albumin levels and assessment of in-hospital mortality or neurologic outcomes. Two reviewers independently assessed the methodological quality of the included studies using the Quality in Prognosis Studies tool. We included 3837 patients from seven observational studies in this systematic review and meta-analysis. The serum albumin level was significantly higher in survivors than in non-survivors, showing a positive association with an overall standardized mean difference (SMD) [(mean value of non-survivors—mean value of survivors)/pooled standard deviation] of 0.55 (95% confidence interval [CI], 0.48−0.62; I2 = 0%; p < 0.001). Additionally, the serum albumin level was significantly higher in the good neurologic outcome group than in the poor neurologic outcome group (four studies; SMD = 1.01, 95% CI = 0.49−1.52, I2 = 87%; p < 0.001). Relatively low serum albumin levels in the early phase may be associated with in-hospital mortality of resuscitated patients after cardiac arrest. However, we could not evaluate the association between albumin level and neurologic outcome because of limited included studies and unresolved high heterogeneity.
Collapse
|
32
|
The Prognostic Accuracy Evaluation of mNUTRIC, APACHE II, SOFA, and SAPS 2 Scores for Mortality Prediction in Patients with Sepsis. Crit Care Res Pract 2022; 2022:4666594. [PMID: 36274819 PMCID: PMC9584740 DOI: 10.1155/2022/4666594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background The modified Nutrition Risk in the Critically Ill (mNUTRIC) score is a helpful tool to evaluate nutritional risk in critically ill patients. However, there is a lack of data on the relationship between mNUTRIC score and septic patients' outcomes. So, this study aims to validate the prognostic role of the mNUTRIC score and to compare the performances of mNUTRIC, APACHE II, SOFA, and SAPS 2 scores for mortality prediction in patients with sepsis. Methods This prospective observational study was performed on 194 septic patients admitted to the Intensive Care Unit (ICU) of 108 Military Central Hospital. Sepsis was defined based on the sepsis-3 definition. The mNUTRIC score was used to evaluate the nutritional status within 24 h of ICU admission. Baseline characteristics and clinical information were collected to calculate the mNUTRIC, APACHE II, SOFA, and SAPS 2 scores. The outcome was in-hospital mortality from all causes. Results Nonsurvivors patients had a significantly higher median mNUTRIC score (6 vs. 4, P < 0.001). The mortality rate in the group with a NUTRIC score ≥5 was significantly higher than in the group with a NUTRIC score <5 (56.0% vs 10.2%; P < 0.001). The area under the ROC curves (AUC) for predicting the mortality of mNUTRIC was 0.79 (sensitivity 67.1% and specificity 81.0% (P < 0.001)). Compared with other severity scores in mortality prediction, AUC was 0.78 for APACHE II (sensitivity 84.9% and specificity 67.7%), 0.77 for SOFA score (sensitivity 76.7% and specificity 65.3%), and 0.73 for SAPS 2 (sensitivity 66.1%, specificity 77.7%). In the multivariate analysis, mNUTRIC score was associated with in-hospital mortality (HR, 2.00; 95% CI, 1.54 to 2.58; P < 0.001). Conclusions Our study showed that the mNUTRIC score was similar to severity scores (APACHE II, SOFA, SAPS 2) in mortality prediction and was the independent mortality predictor in patients with sepsis.
Collapse
|
33
|
Sipahioglu H, Onuk S. Lactate dehydrogenase/albumin ratio as a prognostic factor in severe acute respiratory distress syndrome cases associated with COVID-19. Medicine (Baltimore) 2022; 101:e30759. [PMID: 36197158 PMCID: PMC9508955 DOI: 10.1097/md.0000000000030759] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Patients with severe acute respiratory distress syndrome (ARDS) have high mortality rates; therefore, new biomarkers are necessary to predict the prognosis in the early stages. Serum lactate dehydrogenase (LDH) level is a specific marker of lung damage, but it is not sensitive because it is affected by several factors. This study aimed to determine whether the LDH/albumin ratio could be used as a prognostic biomarker in patients with severe ARDS due to COVID 19. METHODS Tertiary intensive care unit (ICU) patients with severe ARDS and confirmed COVID-19 diagnosis between August 1, 2020, and October 31, 2021, were included. The demographic and clinical characteristics of the patients were recorded from the hospital databases, together with laboratory results on the day of admission to the ICU and the length of stay in the ICU and hospital. LDH/albumin, lactate/albumin, C-reactive protein (CRP)/albumin, and BUN/albumin ratios were calculated. Logistic regression analysis was performed to determine independent risk factors affecting mortality. RESULTS Nine hundred and five patients hospitalized in a tertiary ICU were evaluated. Three hundred fifty-one patients with severe ARDS were included in this study. The mortality rate of the included patients was 61.8% (of 217/351). LDH/albumin, lactate/albumin, and BUN/albumin ratios were higher in the nonsurvivor group (P < .001). The area under the curve (AUC) from the receiver operating characteristic analysis that predicted in-hospital mortality was 0.627 (95% confidence intervals (CI): 0.574-0.678, P < .001) for the LDH/albumin ratio, 0.605 (95% CI: 0.551-0.656, P < .001) for lactate/albumin, and 0.638 (95% CI: 0.585-0.688, P < .001) for BUN/albumin. However, LDH/albumin ratio was independently associated with mortality in multivariate logistic regression analysis. CONCLUSION LDH/albumin ratio can be used as an independent prognostic factor for mortality in patients with severe ARDS caused by COVID-19.
Collapse
Affiliation(s)
- Hilal Sipahioglu
- Department of intensive Care, Kayseri Training and Research Hospital, Kayseri, Turkey
- *Correspondence: Hilal Sipahioglu, Department of Intensive Care, Kayseri Training and Research Hospital, Kayseri 38070, Turkey (e-mail: )
| | - Sevda Onuk
- Department of intensive Care, Kayseri Training and Research Hospital, Kayseri, Turkey
| |
Collapse
|
34
|
Wang Z, Zhang L, Li S, Xu F, Han D, Wang H, Huang T, Yin H, Lyu J. The relationship between hematocrit and serum albumin levels difference and mortality in elderly sepsis patients in intensive care units-a retrospective study based on two large database. BMC Infect Dis 2022; 22:629. [PMID: 35850582 PMCID: PMC9295343 DOI: 10.1186/s12879-022-07609-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sepsis still threatens the lives of more than 300 million patients annually and elderly patients with sepsis usually have a more complicated condition and a worse prognosis. Existing studies have shown that both Hematocrit (HCT) and albumin (ALB) can be used as potential predictors of sepsis, and their difference HCT-ALB has a significant capacity to diagnose infectious diseases. Currently, there is no relevant research on the relationship between HCT-ALB and the prognosis of elderly sepsis patients. Therefore, this study aims to explore the association between HCT-ALB and mortality in elderly patients with sepsis. METHODS This study was a multi-center retrospective study based on the Medical Information Mart for Intensive Care (MIMIC-IV) database and the eICU Collaborative Research Database (eICU-CRD) in elderly patients with sepsis. The optimal HCT-ALB cut-off point for ICU mortality was calculated by the Youden Index based on the eICU-CRD dataset, and multivariate logistic regressions were conducted to explore the association between HCT-ALB and ICU/hospital mortality in the two databases. Subgroup analyses were performed for different parameters and comorbidity status. RESULTS The number of 16,127 and 3043 elderly sepsis patients were selected from two large intensive care databases (eICU-CRD and MIMIC-IV, respectively) in this study. Depending on the optimal cut-off point, patients in both eICU-CRD and MIMIC-IV were independently divided into low HCT-ALB (< 6.7) and high HCT-ALB (≥ 6.7) groups. The odds ratio (95%confidence interval) [OR (95CI%)] of the high HCT-ALB group were 1.50 (1.36,1.65) and 1.71 (1.58,1.87) for ICU and hospital mortality in the eICU-CRD database after multivariable adjustment. Similar trends in the ICU and hospital mortality [OR (95%CI) 1.41 (1.15,1.72) and 1.27 (1.07,1.51)] were observed in MIMIC-IV database. Subgroup analysis showed an interaction effect with SOFA score in the eICU-CRD database however not in MIMIC-IV dataset. CONCLUSIONS High HCT-ALB (≥ 6.7) is associated with 1.41 and 1.27 times ICU and hospital mortality risk in elderly patients with sepsis. HCT-ALB is simple and easy to obtain and is a promising clinical predictor of early risk stratification for elderly sepsis patients in ICU.
Collapse
Affiliation(s)
- Zichen Wang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, People's Republic of China.,Department of Public Health, University of California, Irvine, CA, USA
| | - Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, People's Republic of China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hao Wang
- Department of Statistics, Iowa State University, Ames, USA
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China. .,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China.
| |
Collapse
|
35
|
C-Reactive Protein-to-Albumin Ratio as an Early Biomarker to Identify Sepsis in Neonates with Pneumonia. Mediators Inflamm 2022; 2022:4711018. [PMID: 35873709 PMCID: PMC9303482 DOI: 10.1155/2022/4711018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Neonates with pneumonia often also have sepsis, and the identifying sepsis from pneumonia may be a challenge for clinicians. However, there are no available data regarding the clinical value C-reactive protein-to-albumin ratio (CAR) in identifying sepsis in neonates with pneumonia. The aim of this study was to evaluate the clinical value of CAR in identifying sepsis in neonates with pneumonia. Methods 847 neonates with pneumonia were included in this study, of which 511 neonates were diagnosed with sepsis. Neonates were divided into the sepsis group and the nonsepsis group. All neonates underwent extensive and necessary clinical and laboratory tests. CAR was calculated as serum C-reactive protein (ng/ml)/albumin (mg/ml). All statistical analyses were performed using the statistical package SPSS 24.0, as appropriate. Results Compared with the nonsepsis group, neonates with sepsis have a higher CAR (P < 0.001). Further analysis showed that the prevalence of neonates with sepsis increased significantly from 41.0% in the low CAR group (CAR ≤ 0.024 × 10−3) to 80.0% in the high CAR group (CAR > 0.024 × 10−3) (P < 0.001). Correlation analysis showed that there was a strong positive correlation between CAR and PCT (r = 0.452, P < 0.001), nSOFA (r = 0.267, P < 0.001), and the prolonged length of hospital stay (r = 0.311, P < 0.001). Multiple logistic regression showed that CAR was an independent risk factor for the presence of sepsis in neonates with pneumonia. Receiver operating characteristic curve analysis revealed that CAR had adequate discriminatory power in predicting sepsis in neonates with pneumonia (area under curve (AUC) = 0.76, 95% CI 0.73-0.79, P < 0.001). Conclusions CAR can be used as a new marker to identify sepsis in neonates with pneumonia.
Collapse
|
36
|
Li T, Li X, Liu X, Zhu Z, Zhang M, Xu Z, Wei Y, Feng Y, Qiao X, Yang J, Dong G. Association of Procalcitonin to Albumin Ratio with the Presence and Severity of Sepsis in Neonates. J Inflamm Res 2022; 15:2313-2321. [PMID: 35437348 PMCID: PMC9013250 DOI: 10.2147/jir.s358067] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 12/17/2022] Open
Abstract
Purpose Previous studies have demonstrated that procalcitonin and albumin have a close correlation with sepsis. However, the role of procalcitonin (PCT) to albumin (ALB) ratio (PAR) in sepsis was still unclear, especially in neonates. Thus, this study aimed to investigate the association between PAR and neonatal sepsis. Patients and Methods A total of 1,196 neonates with suspected sepsis were included in this study. Neonates were divided into control group and sepsis group, according to whether they were diagnosed with sepsis. Neonates with sepsis were further divided into mild sepsis and severe sepsis group according to the severity of sepsis. PAR was calculated as serum PCT (ng/mL)/ALB (mg/mL). All statistical analyses were performed using the statistical package SPSS 24.0, as appropriate. Results Compared with the control group, neonates with sepsis had a higher PAR. PAR also showed a significant gradual increase in the control, mild sepsis, and severe sepsis groups (P<0.001). Correlation analysis showed that there was a strong positive correlation between PAR and hsCRP, neonatal sequential organ failure assessment score (nSOFA), and prolonged length of hospital stay (P<0.001). On multiple logistic regression, higher PAR was independently associated with the presence and severity of neonatal sepsis. According to the receiver operating characteristic curve analysis, a PAR ≥0.065 had 64% sensitivity and 72% specificity in predicting the presence of neonatal sepsis (area under curve (AUC)=0.72, 95% CI=0.69–0.75, P<0.001) and a PAR≥0.070 had 69% sensitivity and 63% specificity in predicting the presence of severe sepsis (AUC=0.71, 95% CI=0.68–0.74, P<0.001). Conclusion PAR is significantly higher in neonates with sepsis and correlated with the severity of the disease. Increased PAR is an independent predictor useful for identifying the presence and severity of neonatal sepsis.
Collapse
Affiliation(s)
- Tiewei Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Xiaojuan Li
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Xinrui Liu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Zhiwei Zhu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Min Zhang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Zhe Xu
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Yulei Wei
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Yichuang Feng
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| | - Xiaoliang Qiao
- Center of Laboratory Medicine, Women & Infants Hospital of Zhengzhou, Zhengzhou, People’s Republic of China
| | - Junmei Yang
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
- Correspondence: Junmei Yang; Geng Dong, Email ;
| | - Geng Dong
- Zhengzhou Key Laboratory of Children’s Infection and Immunity, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Zhengzhou, People’s Republic of China
| |
Collapse
|
37
|
Deng J, Zhang S, Peng F, Zhang Q, Li Y, Zhong Y. The Association Between FT3 With the Outcome and Inflammation/Coagulopathy/Fibrinolysis of COVID-19. Front Endocrinol (Lausanne) 2022; 13:877010. [PMID: 35721727 PMCID: PMC9204000 DOI: 10.3389/fendo.2022.877010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/27/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has caused substantial threats to people's physical health and lives, claiming the lives of over 5 million people worldwide. It is imperative to identify the disease severity and intervene with effective therapy as early as possible. Previous studies have shown that low free triiodothyronine (FT3) may possess the predictive value on COVID-19 prognosis. METHODS In this retrospective cohort study, 15-day clinical and laboratory data of 186 hospitalized patients of COVID-19 after admission were analyzed. Groups were based on the disease severity of COVID-19, survival or non-survival, and presence or absence of euthyroid sick syndrome (ESS). Categorical variables were compared with the chi-square test or Fisher's exact test. Continuous variables were tested by Wilcoxon rank-sum test for the non-normal distribution. Spearman correlations were used to assess the correlations between FT3 with clinic parameters of multiple time points. RESULTS The non-survival patients had significant lower levels of FT3 (3.24 ± 0.42 vs. 4.19 ± 0.08 pmol/L, p < 0.05) and thyroid-stimulating hormone (TSH) (0.69 ± 0.19 vs. 2.32 ± 0.2 uIU/ml, p < 0.05), and the FT3 of severe patients was significantly lower than that of non-severe patients (3.67 ± 0.14 vs. 4.33 ± 0.09 pmol/L, p < 0.05). Fifty-nine cases of COVID-19 patients were diagnosed with ESS. Compared with non-ESS patients, those with ESS were older and had higher proportions of fever, shortness of breath, hypertension, diabetes, severe disease, and mortality. In addition, the correlation analysis between FT3 and clinical parameters showed that FT3 were positively related to the lymphocyte count and albumin and negatively correlated with C-reactive protein, erythrocyte sedimentation rate, and D-dimer at all time points in the first 15 days after admission. CONCLUSION Low FT3 had a significant predictive value on the prognosis of COVID-19 patients, and FT3 was significantly related with clinic parameters of inflammation/coagulopathy/fibrinolysis.
Collapse
Affiliation(s)
- Jiayi Deng
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Siye Zhang
- Critical Care Medicine, Hunan Provincial People’s Hospital, Changsha, China
| | - Fei Peng
- Department of Respiratory, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Quan Zhang
- Department of Respiratory, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi Li
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjun Zhong
- Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Yanjun Zhong,
| |
Collapse
|
38
|
Chen C, Chen X, Chen J, Xing J, Hei Z, Zhang Q, Liu Z, Zhou S. Association between Preoperative hs-crp/Albumin Ratio and Postoperative sirs in Elderly Patients: A Retrospective Observational Cohort Study. J Nutr Health Aging 2022; 26:352-359. [PMID: 35450991 DOI: 10.1007/s12603-022-1761-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Systemic inflammatory response syndrome (SIRS) is one of the severe postoperative complications in elderly patients and seriously affects their prognosis and survival rate. Heretofore, there have been no reliable and accurate methods to predict postoperative SIRS in elderly patients. The aim of this study was to determine whether increased preoperative hs-CRP/albumin ratio (CAR) was associated with postoperative SIRS in elderly population. METHODS The data of patients aged ≥ 65 years who underwent general anesthesia in two centers of Third Affiliated Hospital of Sun Yat-sen University between January 2015 and September 2020 were retrieved and analyzed. Based on the perioperative dataset, we used the targeted maximum likelihood estimation (TMLE) to estimate the association between preoperative CAR and postoperative SIRS in elderly population. Patients' CAR was calculated and divided into two groups (< 0.278 and ≥ 0.278) according to its normal range in our hospital. Adjusted odd ratios (aORs) and 95% confidence intervals (CIs) were calculated respectively. Further sensitivity analyses were conducted to evaluate the robustness of the results. RESULTS A total of 16141 elderly patients were accessed and 7009 of them were enrolled in the final analysis, and 1674 (23.9%) patients developed SIRS within 3 days after surgery. Compared with non-SIRS patients, patients with SIRS had a significantly longer postoperative hospitalization, higher cost and higher risk of in-hospital mortality. Compared with patients with preoperative CAR < 0.278, we found that CAR ≥ 0.278 had a significantly higher risk for the development of postoperative SIRS after multivariable adjustment [aOR = 1.27; 95% CI (1.21, 1.33)]. The interaction effect of preoperative CAR ≥ 0.278 and SIRS was stronger among patients with the following characteristics: aged ≥ 75 years, male, comorbid with diabetes mellitus and admitted to ICU after surgery, duration of surgery < 120 minutes, underwent cerebral surgery or skin, spine and joint surgery (all P < 0.001). The above results remained robust in the sensitivity analysis. CONCLUSIONS Preoperative CAR ≥ 0.278 was significantly associated with increased risk of postoperative SIRS in elderly patients. Special attention should be paid to elderly patients with a preoperative CAR ≥ 0.278 so as to reduce the incidence of postoperative SIRS.
Collapse
Affiliation(s)
- C Chen
- Shaoli Zhou, M.D., Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong Province, 510630, China,
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Hu J, Lv C, Hu X, Liu J. Effect of hypoproteinemia on the mortality of sepsis patients in the ICU: a retrospective cohort study. Sci Rep 2021; 11:24379. [PMID: 34934165 PMCID: PMC8692355 DOI: 10.1038/s41598-021-03865-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/06/2021] [Indexed: 12/28/2022] Open
Abstract
The objective of the study was to evaluate the effect of hypoproteinemia on the prognosis of sepsis patients and the effectiveness of exogenous albumin supplementation. A retrospective cohort study was conducted in adult ICUs. The subjects were 1055 sepsis patients in MIMIC III database from June 2001 to October 2012. There were no interventions. A total of 1055 sepsis patients were enrolled and allocated into two groups based on the lowest in-hospital albumin level: 924 patients were in the hypoproteinemia group (the lowest in-hospital albumin ≤ 3.1 g/dL) and 131 patients were in the normal group (the lowest in-hospital albumin > 3.1 g/dL). A total of 378 patients [331 (35.8%) were in the hypoproteinemia group, and 47 (35.9%) were in the normal group] died at 28 days, and no statistically significant difference was found between the two groups (P = 0.99). The survival analysis of the 28-day mortality rate was performed using the Cox proportional risk model and it was found that the lowest in-hospital albumin level showed no significant effect on the 28-day mortality rate (P = 0.18, 95%CI). Patients in the hypoproteinemia group exhibited a longer length of stay in ICU and hospital and more complications with AKI than those in the normal group. However, multivariate regression analysis found that there was no statistical significance between the two groups. In addition, multivariate regression analysis showed that patients in the hypoproteinemia group had a shorter time without vasoactive drugs and time without mechanical ventilation than those in the normal group (P < 0.01). In the subgroup analysis, univariate analysis and multivariate regression analysis showed that there was no significant difference in the 28-day mortality rate (39.6% vs 37.5%, P = 0.80), the proportion of mechanical ventilation time (P = 0.57), and vasoactive drug time (P = 0.89) between patients with and without albumin supplementation. However, patients in the albumin supplementation group had a longer length of ICU stay and hospital stay than those in the non-supplementation group (P < 0.01). Albumin level may be an indicator of sepsis severity, but hypoproteinemia has no significant effect on the mortality of sepsis patients. Despite various physiological effects of albumin, the benefits of albumin supplementation in sepsis patients need to be evaluated with caution.
Collapse
Affiliation(s)
- Jing Hu
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Chenwei Lv
- Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Xingxing Hu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China. .,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China. .,Emergency Department, Jiangsu Province Academy of Traditional Chinese Medicine, No.100 Cross Street, Hongshan Road, Nanjing, Jiangsu, China.
| | - Jiangyun Liu
- Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China. .,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China. .,Neurology Department, Jiangsu Province Academy of Traditional Chinese Medicine, No.100 Cross Street, Hongshan Road, Nanjing, Jiangsu, China.
| |
Collapse
|
40
|
Correlation of Serum Albumin Level to Lung Ultrasound Score and Its Role as Predictors of Outcome in Acute Respiratory Distress Syndrome Patients: A Prospective Observational Study. Crit Care Res Pract 2021; 2021:4594790. [PMID: 34917416 PMCID: PMC8670905 DOI: 10.1155/2021/4594790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
Abstract
Background There is ambiguity in the literature regarding hypoalbuminemia as a cause of extravascular lung water and acute respiratory distress syndrome (ARDS) outcomes. The aim of the study was to determine if low serum albumin on admission leads to lung deaeration and higher lung ultrasound score (LUSS) in ARDS patients. Patients and Methods. It was a prospective observational study in which 110 ARDS patients aged between 18 and 70 years were recruited. Serum albumin level and lung ultrasound score were assessed on the day of ICU admission. Length of ICU stay and hospital mortality were recorded. Results The mean and standard deviation of serum albumin level in mild, moderate, and severe ARDS was 2.92 ± 0.65 g/dL, 2.91 ± 0.77 g/dL, and 3.21 ± 0.85 g/dL, respectively. Albumin level was not correlated to the global LUSS (Pearson correlation r −0.006, p=0.949) and basal LUSS (r −0.066, p=0.513). The cut-off value of albumin for predicting a prolonged length of ICU stay (≥10 days) in ARDS patients was <3.25 g/dL with AUC 0.623, p < 0.05, sensitivity of 86.67%, specificity of 45.45%, and 95% confidence interval (CI) [0.513–0.732], and on multivariate analysis it increased the odds of prolonged ICU stay by 8.9 times (Hosmer and Lemeshow p value 0.810, 95% CI [2.760–28.72]). Serum albumin at admission was not a predictor of mortality. LUSS on the day of admission was not useful to predict either a prolonged length of ICU stay or mortality. Basal LUSS contributed about 56% of the global LUSS in mild and moderate ARDS, and 53% in severe ARDS. Conclusion Serum albumin level was unrelated to LUSS on admission in ARDS patients. Albumin level <3.25 g/dL increased the chances of a prolonged length of ICU stay (≥10 days) but was not associated with an increase in mortality. LUSS on the day of admission could not predict either a prolonged length of ICU stay or mortality. This trial is registered with CTRI/2019/11/021857.
Collapse
|
41
|
Lee BK, Ryu S, Oh SK, Ahn HJ, Jeon SY, Jeong WJ, Cho YC, Park JS, You YH, Kang CS. Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients. Am J Emerg Med 2021; 52:54-58. [PMID: 34864628 DOI: 10.1016/j.ajem.2021.11.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To verify the role of lactate dehydrogenase to albumin (LDH/ALB) ratio as an independent prognostic factor for mortality due to the lower respiratory tract infection (LRTI) in the emergency department (ED). METHODS We reviewed the electronic medical records of patients who were admitted to the ED for the management of LRTI between January 2018 and December 2020. Initial vital signs, laboratory data, and patient severity scores in the ED were collected. The LDH/ALB ratio was compared to other albumin-based ratios (blood urea nitrogen to albumin ratio, C-reactive protein to albumin ratio, and lactate to albumin ratio) and severity scales (pneumonia severity index, modified early warning score, CURB-65 scores), which are being used as prognostic factors for in-hospital mortality. Multivariable logistic regression was performed to identify independent risk factors. RESULTS The LDH/ALB ratio was higher in the non-survivor group than in the survivor group (median [interquartile range]: 217.6 [160.3;312.0] vs. 126.4 [100.3;165.1], p < 0.001). In the comparison of the area under the receiver operating characteristic curve (AUC) for predicting in-hospital mortality, the AUC of the LDH/ALB ratio (0.808, 95% confidence interval: 0.757-0.842, p < 0.001) was wider than other albumin-based ratios and severity scales, except the blood urea nitrogen to albumin ratio. In the multivariable logistic regression analysis, the LDH/ALB ratio independently affected in-hospital mortality. CONCLUSION The LDH/ALB ratio may serve as an independent prognostic factor for in-hospital mortality in patients with LRTI.
Collapse
Affiliation(s)
- Bong-Kyu Lee
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea.
| | - Se-Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Hong-Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - So-Young Jeon
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Won-Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Yong-Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Jung-Soo Park
- Department of Emergency Medicine, School of medicine, Chungnam National University, Jung-Gu, Daejeon, Republic of Korea
| | - Yeon-Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Chang-Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| |
Collapse
|
42
|
Chen X, Zhou X, Zhao H, Wang Y, Pan H, Ma K, Xia Z. Clinical Value of the Lactate/Albumin Ratio and Lactate/Albumin Ratio × Age Score in the Assessment of Prognosis in Patients With Sepsis. Front Med (Lausanne) 2021; 8:732410. [PMID: 34722573 PMCID: PMC8553960 DOI: 10.3389/fmed.2021.732410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine the clinical significance of the blood lactate (Lac)/serum albumin (Alb) ratio and the Lac/Alb × age score for assessing the severity and prognosis of patients with sepsis. Methods: A total of 8,029 patients with sepsis, aged >18 years were enrolled between June 2001 to October 2012 from the latest version of the Medical Information Mart for Intensive Care III (MIMIC-III v.1.4). The general data of the patients were obtained from hospital records and included gender, age, body mass index (BMI), laboratory indices, the sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS II). The patients were graded and scored according to their age and then divided into a survival or death group based on their prognosis. The Lac/Alb ratio after ICU admission was calculated and compared between the two groups. The risk factors for death in patients with sepsis were determined using multivariate logistic regression analysis, while mortality was examined using receiver operating characteristic (ROC) curve and survival curve plots. Finally, the values of the Lac/Alb ratio and Lac/Alb × age score for assessing prognosis of patients with sepsis were analyzed and compared. Results: After items with default values were excluded, a total of 4,555 patients with sepsis were enrolled (2,526 males and 2,029 females). 2,843 cases were classified as the death group and 1,712 cases in the survival group. (1) The mean age, BMI, SOFA and SAPS II scores were higher in the death group than those in the survival group. Significant differences in baseline data between the two groups were also observed. (2) The patients in the death group were divided further into four subgroups according to the quartile of the Lac/Alb ratio from low to high. Comparison of the four subgroups showed that the death rate rose with an increase in the Lac/Alb ratio, while analysis of the survival curve revealed that patients with a higher Lac/Alb ratio had a worse prognosis. (3) Multivariate logistic regression analysis showed that age ≥ 60 years, overweight (BMI ≥ 24 kg/m2), Lac/Alb ratio ≥ 0.16, SOFA score ≥ 2 points, and SAPS II ≥ 40 points were independent risk factors for death in patients with septic. (4) ROC curve analysis indicated that the SAPS II, Lac/Alb x age score, SOFA, and Lac/Alb ratio were the best predictors of death in patients with sepsis. The Lac/Alb × age score was characterized by its simple acquisition and ability to quickly analyze the prognosis of patients. Conclusion: (1)A high Lac/Alb ratio is an independent risk factor for death in patients with sepsis. (2) Although the prognosis of sepsis can be accurately and comprehensively assessed by multi-dimensional analysis of multiple indices, the Lac/Alb×age score is more accurate and convenient for providing a general assessment of prognosis, so is worthy of further clinical recognition.
Collapse
Affiliation(s)
- Xiaonan Chen
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Xinjian Zhou
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Hui Zhao
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Yanxue Wang
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Hong Pan
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Ke Ma
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| | - Zhijie Xia
- Department of Emergency and Critical Care Medicine, Fudan University Affiliated North Huashan Hospital, Shanghai, China
| |
Collapse
|
43
|
Arnau-Barrés I, Pascual-Dapena A, López-Montesinos I, Gómez-Zorrilla S, Sorlí L, Herrero M, Nogués X, Navarro-Valls C, Ibarra B, Canchucaja L, da Costa Venancio E, Blasco-Hernando F, Cruz J, Vázquez O, Miralles R, García-Giralt N, Güerri-Fernández R. Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection. J Clin Med 2021; 10:jcm10215134. [PMID: 34768653 PMCID: PMC8584930 DOI: 10.3390/jcm10215134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/22/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. Methods. Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March–May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. Results. Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff −0.4634; p < 0.001) or IL-6 (Pearson’s Coeff −0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson’s Coeff −0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63–0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03–4.62; p = 0.039). Conclusion. Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.
Collapse
Affiliation(s)
- Isabel Arnau-Barrés
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
| | - Ana Pascual-Dapena
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
- Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Inmaculada López-Montesinos
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Silvia Gómez-Zorrilla
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Luisa Sorlí
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Marta Herrero
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Xavier Nogués
- Department of Internal Medicine, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (X.N.); (N.G.-G.)
| | - Claudia Navarro-Valls
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Beatriz Ibarra
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Lizzeth Canchucaja
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Elizabeth da Costa Venancio
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Fabiola Blasco-Hernando
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Juany Cruz
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
| | - Olga Vázquez
- Department of Geriatrics, Hospital del Mar, 08003 Barcelona, Spain; (I.A.-B.); (M.H.); (B.I.); (L.C.); (E.d.C.V.); (O.V.)
| | - Ramón Miralles
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
| | - Natalia García-Giralt
- Department of Internal Medicine, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (X.N.); (N.G.-G.)
| | - Robert Güerri-Fernández
- Departament de Medicina, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; (A.P.-D.); (R.M.)
- Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Department of Infectious Diseases, Institute Hospital del Mar of Medical Research (IMIM), Hospital del Mar, 08003 Barcelona, Spain; (I.L.-M.); (S.G.-Z.); (L.S.); (C.N.-V.); (F.B.-H.); (J.C.)
- Correspondence: ; Tel.: +34-932483251
| |
Collapse
|
44
|
Jeon SY, Ryu S, Oh SK, Park JS, You YH, Jeong WJ, Cho YC, Ahn HJ, Kang CS. Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care. Medicine (Baltimore) 2021; 100:e27538. [PMID: 34731152 PMCID: PMC8519202 DOI: 10.1097/md.0000000000027538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/28/2021] [Indexed: 01/05/2023] Open
Abstract
This study was performed to verify whether lactate dehydrogenase to albumin (LDH/ALB) ratio could be used as an independent prognostic factor in patients with severe infection requiring intensive care.We reviewed electronic medical records of patients hospitalized to the intensive care unit via the emergency department with a diagnosis of infection between January 2014 and December 2019. From the collected data, ALB-based ratios (LDH/ALB, blood urea nitrogen to albumin, C-reactive protein to albumin, and lactate to albumin ratios) and some severity scores (modified early warning score, mortality in emergency department sepsis score [MEDS], and Acute Physiology And Chronic Health Evaluation II [APACHE II] score) were calculated. LDH/ALB ratio for predicting the in-hospital mortality was compared with other ALB-based ratios and severity scales by univariable and receiver-operating characteristics curve analysis. Modified severity scores by LDH/ALB ratio and multivariable logistic regression were used to verify the independence and usefulness of the LDH/ALB ratio.The median LDH/ALB ratio was higher in non-survivors than survivors (166.9 [interquartile range: 127.2-233.1] vs 214.7 [interquartile range: 160.2-309.7], P < .001). The area under the receiver-operating characteristics curve of the LDH/ALB ratio (0.642, 95% confidence interval: 0.602-0.681, P < .001) was not lower than that of other ALB-based ratios and severity scores. From multivariable logistic regression, LDH/ALB ratio was independently associated with in-hospital mortality (odds ratio = 1.001, 95% confidence interval: 1.000-1.002, P = .047). Area under the receiver-operating characteristics curves of MEDS and APACHE II scores were improved by modification with LDH/ALB ratio (MEDS: 0.643 vs 0.680, P < .001; APACHE II score: 0.675 vs 0.700, P = .003).LDH/ALB ratio may be useful as the prognostic factor in patients with severe infection requiring intensive care.
Collapse
Affiliation(s)
- So Young Jeon
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Seung Ryu
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Se-Kwang Oh
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Jung-Soo Park
- Department of Emergency Medicine, Chungnam National University, Jung-Gu, Daejeon, Republic of Korea
| | - Yeon-Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Won-Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Yong-Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Hong-Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| | - Chang-Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-Gu, Daejeon, Republic of Korea
| |
Collapse
|
45
|
Turcato G, Zaboli A, Kostic I, Melchioretto B, Ciccariello L, Zaccaria E, Olivato A, Maccagnani A, Pfeifer N, Bonora A. Severity of SARS-CoV-2 infection and albumin levels recorded at the first emergency department evaluation: a multicentre retrospective observational study. Emerg Med J 2021; 39:63-69. [PMID: 34548413 PMCID: PMC8457997 DOI: 10.1136/emermed-2020-210081] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 09/02/2021] [Indexed: 01/08/2023]
Abstract
Background The aim of this study was to investigate the association between serum albumin levels in the ED and the severity of SARS-CoV-2 infection. Methods This is a retrospective observational study conducted from 15 March 2020 to 5 April 2020 at the EDs of three different hospitals in Italy. Data from 296 patients suffering from COVID-19 consecutively evaluated at EDs at which serum albumin levels were routinely measured on patients’ arrival in the ED were analysed. Albumin levels were measured, and whether these levels were associated with the presence of severe SARS-CoV-2 infection or 30-day survival was determined. Generalised estimating equation models were used to assess the relationship between albumin and study outcomes, and restricted cubic spline (RCS) regression was used to plot the adjusted dose-effect relationship for possible clinical confounding factors. Results The mean albumin level recorded on entry was lower in patients with severe SARS-CoV-2 infection than in those whose infections were not severe (3.5 g/dL (SD 0.3) vs 4 g/dL (SD 0.5)) and in patients who had died at 30 days post-ED arrival compared with those who were alive at this time point (3.3 g/dL (SD 0.3) vs 3.8 g/dL (SD 0.4)). Albumin <3.5 g/dL was an independent risk factor for both severe infection and death at 30 days, with adjusted odd ratios of 2.924 (1.509–5.664) and 2.615 (1.131–6.051), respectively. RCS analysis indicated that there was an adjusted dose–response association between the albumin values recorded on ED and the risk of severe infection and death. Conclusion Albumin levels measured on presentation to the ED may identify patients with SARS-CoV-2 infection in whom inflammatory processes are occurring and serve as a potentially useful marker of disease severity and prognosis.
Collapse
Affiliation(s)
- Gianni Turcato
- Emergency Department, Ospedale di Merano, Merano, Alto Adige, Italy
| | - Arian Zaboli
- Emergency Department, Ospedale di Merano, Merano, Alto Adige, Italy
| | - Irena Kostic
- Emergency Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - Barbara Melchioretto
- Emergency Department, Università degli Studi di Verona Dipartimento di Medicina, Verona, Veneto, Italy
| | - Laura Ciccariello
- Emergency Department, Ospedale di Bressanone, Bressanone, Trentino Alto Adige, Italy
| | - Eleonora Zaccaria
- Emergency Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - Alessia Olivato
- Emergency Department, Università degli Studi di Verona Dipartimento di Medicina, Verona, Veneto, Italy
| | - Antonio Maccagnani
- Emergency Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - Norbert Pfeifer
- Emergency Department, Ospedale di Merano, Merano, Alto Adige, Italy
| | - Antonio Bonora
- Emergency Department, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| |
Collapse
|
46
|
Zhou D, Wang J, Li X. The Red Blood Cell Distribution Width-Albumin Ratio Was a Potential Prognostic Biomarker for Diabetic Ketoacidosis. Int J Gen Med 2021; 14:5375-5380. [PMID: 34522133 PMCID: PMC8434876 DOI: 10.2147/ijgm.s327733] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/10/2021] [Indexed: 12/18/2022] Open
Abstract
Background The red blood cell distribution width (RDW)–albumin ratio (RA) is a new biomarker, which is d-efined as RDW divided by albumin. This study aimed at determining the prognostic values of RA for diabetic ketoacidosis (DKA). Methods Data were obtained from Medical Information Mart for Intensive Care Database III V1.4 (MIMIC-III) and the RA calculated. Multivariate Cox regression analysis was performed to determine the correlation between RA and 90-day mortality or 365-day mortality. To further investigate the association with RA and mortality, the patients were divided into two groups. The second outcome was the association between the incidence of DKA-related infections and RA. Results For DKA patients in the ICU, RA was significantly correlated with 90-day mortality (HR: 2.1, 95% CI: 1.5, 3.0, p < 0.001) and 365-day mortality (HR: 1.9, 95% CI: 1.5, 2.5, p < 0.001). A high RA was independently correlated with increased 90-day mortality (HR: 7.8, 95% CI: 1.8, 34.0, p for trend <0.001) and 365-day mortality (HR: 5.2, 95% CI: 2.4, 11.3, p for trend <0.001). Moreover, RA was found to be an independent predictor for sepsis and septic shock in patients with DKA (HR: 2.9, 95% CI: 2.0, 4.1, p < 0.001). After adjusting for confounders, the statistical outcome was the same. Conclusion A high RA is significantly correlated with increased all-cause mortality of DKA as well as an increased incidence of DKA-related infections. RA is a potential prognostic marker for DKA.
Collapse
Affiliation(s)
- Depu Zhou
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin Province, People's Republic of China
| | - Jie Wang
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin Province, People's Republic of China
| | - Xiaokun Li
- Department of Endocrinology, Yanbian University Hospital, Yanji, Jilin Province, People's Republic of China
| |
Collapse
|
47
|
Zeng Z, Yao S, Zheng J, Gong X. Development and validation of a novel blending machine learning model for hospital mortality prediction in ICU patients with Sepsis. BioData Min 2021; 14:40. [PMID: 34399809 PMCID: PMC8365981 DOI: 10.1186/s13040-021-00276-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/08/2021] [Indexed: 11/12/2022] Open
Abstract
Background Early prediction of hospital mortality is crucial for ICU patients with sepsis. This study aimed to develop a novel blending machine learning (ML) model for hospital mortality prediction in ICU patients with sepsis. Methods Two ICU databases were employed: eICU Collaborative Research Database (eICU-CRD) and Medical Information Mart for Intensive Care III (MIMIC-III). All adult patients who fulfilled Sepsis-3 criteria were identified. Samples from eICU-CRD constituted training set and samples from MIMIC-III constituted test set. Stepwise logistic regression model was used for predictor selection. Blending ML model which integrated nine sorts of basic ML models was developed for hospital mortality prediction in ICU patients with sepsis. Model performance was evaluated by various measures related to discrimination or calibration. Results Twelve thousand five hundred fifty-eight patients from eICU-CRD were included as the training set, and 12,095 patients from MIMIC-III were included as the test set. Both the training set and the test set showed a hospital mortality of 17.9%. Maximum and minimum lactate, maximum and minimum albumin, minimum PaO2/FiO2 and age were important predictors identified by both random forest and extreme gradient boosting algorithm. Blending ML models based on corresponding set of predictors presented better discrimination than SAPS II (AUROC, 0.806 vs. 0.771; AUPRC 0.515 vs. 0.429) and SOFA (AUROC, 0.742 vs. 0.706; AUPRC 0.428 vs. 0.381) on the test set. In addition, calibration curves showed that blending ML models had better calibration than SAPS II. Conclusions The blending ML model is capable of integrating different sorts of basic ML models efficiently, and outperforms conventional severity scores in predicting hospital mortality among septic patients in ICU. Supplementary Information The online version contains supplementary material available at 10.1186/s13040-021-00276-5.
Collapse
Affiliation(s)
- Zhixuan Zeng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China.,Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China
| | - Shuo Yao
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China.,Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China
| | - Jianfei Zheng
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China.,Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China
| | - Xun Gong
- Department of Emergency Medicine, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China. .,Emergency Medicine and Difficult Diseases Institute, Second Xiangya Hospital, Central South University, No.139, Middle Renmin Road, Changsha, 410011, Hunan Province, China.
| |
Collapse
|
48
|
Hu T, Zhang Z, Jiang Y. Albumin corrected anion gap for predicting in-hospital mortality among intensive care patients with sepsis: A retrospective propensity score matching analysis. Clin Chim Acta 2021; 521:272-277. [PMID: 34303712 DOI: 10.1016/j.cca.2021.07.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/18/2021] [Accepted: 07/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relationship between albumin corrected anion gap (ACAG) and in-hospital mortality of intensive care sepsis patients is currently inconclusive. METHODS The baseline data, concentration of albumin, anion gap (AG), ACAG and in-hospital prognosis of intensive care patients with sepsis were retrieved from the Medical Information Mart for Intensive Care IV database. Propensity score matching (PSM) analysis was performed to reduce bias. Receiver operating characteristic curves were drawn for albumin, AG, and ACAG, and comparisons between the areas under the ROC curves were conducted. Decision curve analysis (DCA) was performed to determine the net benefit of ACAG. RESULTS ACAG was related to in-hospital mortality in intensive care patients with sepsis. The AUCs of ACAG were 0.689 (before PSM) and 0.644 (after PSM), which were significantly higher than that of albumin or AG. The Youden's index of ACAG was the highest, and the net benefit range of ACAG was also the largest according to the DCA. CONCLUSIONS ACAG has the highest predictive value for in-hospital mortality of intensive care patients with sepsis, which is better than albumin and AG. Using ACAG to predict the in-hospital mortality to guide clinical applications may obtain the highest net benefit.
Collapse
Affiliation(s)
- Tianyang Hu
- Department of Cardiology, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhengwei Zhang
- Department of Critical Care Medicine, Chengdu Second People's Hospital, Chengdu, China
| | - Youfan Jiang
- Department of Respiration, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
| |
Collapse
|
49
|
Abstract
BACKGROUND Circulating complement C3 fragments released during septic shock might contribute to the development of complications such as profound hypotension and disseminated intravascular coagulation. The role of C3 in the course of septic shock varies in the literature, possibly because circulating C3 exists in different forms indistinguishable via traditional ELISA-based methods. We sought to test the relationship between C3 forms, measured by Western blotting with its associated protein size differentiation feature, and clinical outcomes. METHODS Secondary analysis of two prospective cohorts of patients with septic shock: a discovery cohort of 24 patents and a validation cohort of 181 patients. C3 levels were measured by Western blotting in both cohorts using blood obtained at enrollment. Differences between survivors and non-survivors were compared, and the independent prognostic values of C3 forms were assessed. RESULTS In both cohorts there were significantly lower levels of the C3-alpha chain in non-survivors than in survivors, and persisted after controlling for sequential organ failure assessment score. Area under the receiver operating characteristics to predict survival was 0.65 (95% confidence interval: 0.56-0.75). At a best cutoff value (Youden) of 970.6 μg/mL, the test demonstrated a sensitivity of 68.5% and specificity of 61.5%. At this cutoff point, Kaplan-Meier survival analysis showed that patients with lower levels of C3-alpha chain had significantly lower survival than those with higher levels (P < 0.001). CONCLUSION Circulating C3-alpha chain levels is a significant independent predictor of survival in septic shock patients.
Collapse
|
50
|
Li Y, She Y, Mo W, Jin B, Xiang W, Luo L. Albumin Level at Admission to the Intensive Care Unit Is Associated With Prognosis in Cardiac Arrest Patients. Cureus 2021; 13:e14501. [PMID: 34007754 PMCID: PMC8123237 DOI: 10.7759/cureus.14501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/17/2022] Open
Abstract
Aim Cardiac arrest is a global health concern with consistently high mortality. It is also a common condition seen in the intensive care unit (ICU). We aimed to investigate the importance of albumin level on admission, which is a widely available and simple test, to predict in-hospital mortality in cardiac arrest patients. Methods The retrospective study collected data from the eICU Collaborative Research Database. It contains data from 171 hospitals, 276 ICU wards, and 4,529 patients who were treated for cardiac arrest from 2014 to 2015. We analyzed the patients' laboratory results and vital signs during the first 24 hours after admission to the ICU. The primary outcome was in-hospital mortality, and the secondary outcome was the length of ICU stay among survivors. Results In total, 2,414 patients were eligible. After adjusting for severity scores, including the Acute Physiology and Chronic Health Evaluation (APACHE) IV and Sequential Organ Failure Assessment (SOFA) scores, serum albumin was found to be a protective factor for survival (odds ratio of mortality: 0635, 95% confidence interval: 0.458-0.734, P<0.001). Among patients who survived until discharge, those with hypoalbuminemia had a long duration of stay in the ICU (P=0.005). Conclusion The higher albumin level at admission to the ICU was associated with lower mortality in patients with cardiac arrest.
Collapse
Affiliation(s)
- Yide Li
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Yingfang She
- Neurology Medicine Center, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Weisheng Mo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Biao Jin
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| | - Wendi Xiang
- Department of Operating Room, Xiangya Hospital of Central South University, Changsha, CHN
| | - Liang Luo
- Department of Critical Care Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, CHN
| |
Collapse
|