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Xu W, Huo J, Hu Q, Xu J, Chen G, Mo J, Zhou T, Jiang J. Association between lactate dehydrogenase to albumin ratio and acute kidney injury in patients with sepsis: a retrospective cohort study. Clin Exp Nephrol 2024; 28:882-893. [PMID: 38584195 DOI: 10.1007/s10157-024-02500-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: 12/13/2023] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Serum lactate dehydrogenase to albumin ratio (LAR) is associated with poor outcomes in malignancy and pneumonia. However, there are few studies suggesting that LAR is associated with the occurrence of acute kidney injury (AKI) in patients with sepsis, which was investigated in this study. METHODS We conducted a retrospective cohort study based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The primary outcome was the occurrence of AKI within 2 days and 7 days. Multivariable logistic regression models were used to calculate odds ratios to validate the association between LAR and AKI, in-hospital mortality, RRT use, and recovery of renal function, respectively. RESULTS A total of 4010 participants were included in this study. The median age of the participants was 63.5 years and the median LAR was 10.5. After adjusting for confounding variables, patients in the highest LAR quartile had a higher risk of AKI than those in the lowest LAR quartile within 2 days and 7 days, with odds ratios of 1.37 (95% confidence interval [CI]: 1.23-1.52) and 1.95 (95% CI: 1.72-2.22), respectively. The adjusted odds of AKI within 2 and 7 days were 1.16 (95% CI: 1.12-1.20) and 1.29 (95% CI: 1.24-1.35) for each 1 unit increase in LAR(log2), respectively. CONCLUSION This study demonstrated that elevated LAR was associated with poor prognosis in patients with sepsis. The risk of AKI and in-hospital mortality increased, the need for RRT increased, and the chance of recovery of renal function decreased with the increase of LAR.
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Affiliation(s)
- Weigan Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China.
| | - Jianyang Huo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Qiaohua Hu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jingtao Xu
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Guojun Chen
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jierong Mo
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Tianen Zhou
- Department of Emergency, First People's Hospital of Foshan, No.18 Lingnan Avenue North, Chancheng District, Foshan, 528000, Guangdong Province, China
| | - Jun Jiang
- First People's Hospital of Foshan, Foshan, Guangdong Province, China
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Fang Y, Zhang Y, Zhang X. The elevated lactate dehydrogenase to albumin ratio is a risk factor for developing sepsis-associated acute kidney injury: a single-center retrospective study. BMC Nephrol 2024; 25:201. [PMID: 38898431 PMCID: PMC11186243 DOI: 10.1186/s12882-024-03636-5] [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: 08/21/2023] [Accepted: 06/12/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND There is no evidence to determine the association between the lactate dehydrogenase to albumin ratio (LAR) and the development of sepsis-associated acute kidney injury (SAKI). We aimed to investigate the predictive impact of LAR for SAKI in patients with sepsis. METHODS A total of 4,087 patients with sepsis from the Medical Information Mart for Intensive Care IV (MIMIC IV) database were included. Logistic regression analysis was used to identify the association between LAR and the risk of developing SAKI, and the relationship was visualized using restricted cubic spline (RCS). The clinical predictive value of LAR was evaluated by ROC curve analysis. Subgroup analysis was used to search for interactive factors. RESULTS The LAR level was markedly increased in the SAKI group (p < 0.001). There was a positive linear association between LAR and the risk of developing SAKI (p for nonlinearity = 0.867). Logistic regression analysis showed an independent predictive value of LAR for developing SAKI. The LAR had moderate clinical value, with an AUC of 0.644. Chronic kidney disease (CKD) was identified as an independent interactive factor. The predictive value of LAR for the development of SAKI disappeared in those with a history of CKD but remained in those without CKD. CONCLUSIONS Elevated LAR 12 h before and after the diagnosis of sepsis is an independent risk factor for the development of SAKI in patients with sepsis. Chronic comorbidities, especially the history of CKD, should be taken into account when using LAR to predict the development of AKI in patients with sepsis.
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Affiliation(s)
- Yipeng Fang
- Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, 57th Changping Road, Shantou, Guangdong Province, 515041, People's Republic of China
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China
- Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China
| | - Yuan Zhang
- Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China
| | - Xin Zhang
- Laboratory of Molecular Cardiology, The First Affiliated Hospital of Shantou University Medical College, 57th Changping Road, Shantou, Guangdong Province, 515041, People's Republic of China.
- Laboratory of Medical Molecular Imaging, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China.
- Shantou University Medical College, Shantou, Guangdong Province, People's Republic of China.
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Chu M, Niu H, Yang N, Wang D, Liu Y, Mao X, Xia S, Wang D, Zhao J. High serum lactate dehydrogenase to albumin ratio is associated with increased risk of poor prognosis after ischemic stroke. Clin Neurol Neurosurg 2024; 237:108120. [PMID: 38266329 DOI: 10.1016/j.clineuro.2024.108120] [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: 11/26/2023] [Revised: 01/07/2024] [Accepted: 01/10/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Lactate dehydrogenase to albumin ratio (LAR) is a comprehensive biomarker for anaerobiosis, inflammation, and nutritional status, but its prognostic value for ischemic stroke has rarely been reported. We aimed to prospectively investigate whether serum LAR is associated with the prognosis of ischemic stroke patients in a large-scale cohort study. MATERIALS AND METHODS Serum LAR levels were measured among 6634 patients with ischemic stroke admitted at Minhang hospital from January 2018 to December 2022. The primary outcome was the composite of major disability and death (modified Rankin Scale score [mRS] ≥ 3) at 3-month follow up. Secondary outcomes included death and the ordered 7-level category score of mRS. Multivariate logistic regression and restricted cubic splines were adopted to evaluate the associations between serum LAR levels and adverse clinical outcomes of ischemic stroke. RESULTS During 3 months of follow-up period, a total of 2125 patients experienced primary outcome. After multivariate adjustment, the highest quartile of serum LAR was associated with an increased risk of primary outcome (odds ratio [OR], 1.52; 95% confidence interval [CI], 1.27-1.83; P for trend < 0.001). Each standard deviation higher log-transformed serum LAR resulted in a 20% (95% CI, 12%-28%) increased risk of primary outcome. Furthermore, multivariable-adjusted restricted cubic spline analyses showed a linear association between the serum LAR level with primary outcome (P for linearity < 0.001). Finally, the addition of serum LAR to conventional risk factors significantly improved risk predictive abilities for the primary outcome (net reclassification improvement [NRI]: 18.35%, P < 0.001; integrated discrimination improvement [IDI]: 0.35%, P < 0.001) at 3-month follow up in patients with ischemic stroke. CONCLUSION High serum LAR level was independently associated with an increased risk of adverse clinical outcomes among patients with ischemic stroke, indicating that serum LAR may be a valuable prognostic biomarker for ischemic stroke.
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Affiliation(s)
- Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Huicong Niu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Ning Yang
- Department of Neurology, Hebei General Hospital, Shijiazhuang 050000, PR China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Xueyu Mao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Shiliang Xia
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai 200032, PR China.
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Zhang F, Zhang M, Niu Z, Sun L, Kang X, Qu Y. Prognostic value of lactic dehydrogenase-to-albumin ratio in critically ill patients with acute respiratory distress syndrome: a retrospective cohort study. J Thorac Dis 2024; 16:81-90. [PMID: 38410562 PMCID: PMC10894402 DOI: 10.21037/jtd-23-1238] [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: 08/07/2023] [Accepted: 11/17/2023] [Indexed: 02/28/2024]
Abstract
Background Lactic dehydrogenase (LDH)-to-albumin ratio (LAR) was an independent risk factor for mortality in the patients with acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19), while the relationship among LAR and short-term, long-term, in-hospital mortalities of ARDS remains unclear. The current study aims to investigate the association between LAR and significant prognosis in patients with ARDS. Methods We conducted a retrospective cohort study and analyzed patients with ARDS on the Medical Information Mart for Intensive Care IV (MIMIC-IV) version 2.0 database. In the current study, 30-day mortality was defined as the primary outcome; 90-day mortality and in-hospital mortality were defined as secondary outcomes. Multivariate regression analysis, Kaplan-Meier curve analysis and subgroup analysis were performed to research the association between LAR and prognosis in patients with ARDS. Results A total of 358 critically ill patients with ARDS were enrolled in the current study. The mean age of the participants was 62.6±16.0 and the median of LAR was 14.3. According to the Kaplan-Meier curve analysis, the higher LAR group had a higher 30-day, 90-day and in-hospital mortalities. We also analyzed the 30-day mortality to receiver operating characteristic (ROC) curves by comparing the value between LAR and LAR + simplified acute physiology score II (SAPS II). The area under the curve (AUC) of the LAR group was 0.694 [95% confidence interval (CI): 0.634-0.754, P<0.001], and 0.661 for the LAR + SAPS II (95% CI: 0.599-0.722, P<0.001). For 30-day mortality, after adjusting for covariates, hazard ratios (HRs) (95% CIs) for tertile 2 (LAR 8.7-30.9) and tertile 3 (LAR >30.9) were 2.00 (1.37, 2.92) and 2.50 (1.50, 4.15), respectively. Similar results were also observed for 90-day mortality and in-hospital mortality. Conclusions Elevated LAR levels are associated with increased 30- and 90-day mortalities, as well as in-hospital mortality in patients with ARDS, which means LAR levels may predict the mortalities of ARDS patients.
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Affiliation(s)
- Fushuai Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Mengyu Zhang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Zongge Niu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Lina Sun
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Xiuhe Kang
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
| | - Yiqing Qu
- Department of Pulmonary and Critical Care Medicine, Qilu Hospital of Shandong University, Jinan, China
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