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Pérez MC, Fernández-Sarmiento J, Bustos JD, Ferro-Jackaman S, Ramírez-Caicedo P, Nieto A, Lucena N, Barrera S, Fernández-Rengifo JM, Cárdenas C, Garavito MC, Fernández-Sarta JP, Rotta IL, Coutin A, Patiño J, Acevedo L, Suárez JD, Duque-Arango C. Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients. Sci Rep 2024; 14:22579. [PMID: 39343791 PMCID: PMC11439901 DOI: 10.1038/s41598-024-73112-5] [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: 05/21/2024] [Accepted: 09/13/2024] [Indexed: 10/01/2024] Open
Abstract
A lactate/albumin ratio (LAR) greater than 0.5 measured early in the course of pediatric critical illness is associated with greater mortality. Whether the elevated LAR can be explained by microcirculation disorders in children with sepsis is not known. In this longitudinal retrospective study (January 2021-January 2024), serum albumin and lactate were measured on admission to the pediatric intensive care unit (PICU), with sublingual video microscopy performed simultaneously to measure microcirculation. A total of 178 children were included, 37% of whom had septic shock measured with the Phoenix Sepsis Score. Patients with remote sepsis had greater odds of an elevated LAR (aOR 6.87: 95% CI 1.98-23.73; p < 0.01). Children with an elevated LAR had more microvascular blood flow abnormalities (aOR 1.31 95% CI 1.08-1.58; p < 0.01), lower 4-6-micron capillary density (aOR 1.03 95% CI 1.01-1.05; p < 0.01) and greater odds of dying (aOR 3.55 95% CI 1.21-10.38; p = 0.02) compared to those with a low LAR. We found no association between LAR and endothelial glycocalyx degradation. A normal LAR is associated with less risk of microcirculatory injury (aOR 0.77 95% CI 0.65-0.93; p < 0.01). In children with sepsis, an elevated LAR is associated with microcirculation abnormalities (microvascular density and flow). The lactate/albumin ratio is a potentially useful biomarker for microcirculatory injury in sepsis.
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Affiliation(s)
- Maria Camila Pérez
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Jaime Fernández-Sarmiento
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia.
| | - Juan David Bustos
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Sarah Ferro-Jackaman
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Paula Ramírez-Caicedo
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Andrés Nieto
- Department of Emergency Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Natalia Lucena
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Sofia Barrera
- Department of Emergency Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - José Manuel Fernández-Rengifo
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Carolina Cárdenas
- Department of Emergency Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Maria Camila Garavito
- Department of Emergency Medicine and Pediatrics, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Juan Pablo Fernández-Sarta
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad del Rosario , Bogotá, Colombia
| | - Isabella La Rotta
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad del Rosario , Bogotá, Colombia
| | - Alejandro Coutin
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad del Rosario , Bogotá, Colombia
| | - Juanita Patiño
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad del Rosario , Bogotá, Colombia
| | - Lorena Acevedo
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Juan David Suárez
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
| | - Catalina Duque-Arango
- Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia
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Kim S, Lee S, Ahn S, Park J, Moon S, Cho H, Choi SH. The prognostic utility of Lactate/Albumin*Age score in septic patient with normal lactate level. Heliyon 2024; 10:e37056. [PMID: 39319119 PMCID: PMC11419914 DOI: 10.1016/j.heliyon.2024.e37056] [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: 01/04/2024] [Revised: 08/09/2024] [Accepted: 08/27/2024] [Indexed: 09/26/2024] Open
Abstract
Background A previous study has shown that the lactate/albumin*age (LAA) score is useful for predicting mortality in patients with sepsis admitted to the ICU. We aimed to evaluate the clinical significance of the LAA score in patients with sepsis who presented to the emergency department (ED). Methods This retrospective observational study used data from the Korean Shock Society Registry collected between January 2017 and December 2021. The prognostic performance of the LAA score for predicting the 28-day mortality was evaluated. Lactate and albumin levels were measured immediately after arrival to the ED. Results Of the 5346 patients with sepsis, data from 3240 were analyzed. The area under the receiver operating characteristic curve (AUROC) of the LAA score (0.737, 95 % confidence interval (CI) 0.716-0.757), was higher than that of lactate (0.699, 95 % CI 0.677-0.720, p < 0.001), lactate/albumin (LA) ratio (0.730, 95 % CI 0.709-0.751, p = 0.016), and Sequential Organ Failure Assessment (SOFA) score (0.698, 95 % confidence interval 0.676-0.720, p = 0. 004), and Acute Physiology and Chronic Health Evaluation (APACHE) II scores (0.672; 95 % confidence interval 0.649-0.694, p < 0.001). The optimal cut-off value for the LAA score was 119.9. In the Kaplan-Meier analysis according to the optimal cutoff value, the 28-day mortality rates were higher in the high LAA score group (log-rank test, p < 0.001). The LAA score was independently associated with 28-day mortality in the multivariate Cox proportional hazards model (adjusted hazard ratio 2.07, 95 % CI 1.76-2.43, p < 0.001). In the normal (<2 mmol/L) lactate group, the AUROC value for LAA score was higher than LA ratio (normal group 0.674 vs 0.634, p < 0.004). In patients over 65 years old, LAA score (0.731) showed a higher AUROC value than LA ratio (0.725). (p < 0.001). Conclusion The LAA score may be used as an independent predictor of mortality in patients with sepsis in the emergency department. Our results show that it performs better than serum lactate alone, LA ratio, and SOFA and APACHE II scores. While this suggests that the LAA could provide clinicians with a useful tool for timely early intervention and care planning in patients with a poor prognosis, further validation in large multicenter prospective studies are necessary to confirm its reliability and practicality as a readily available and objective biomarker.
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Affiliation(s)
- Sungjin Kim
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sukyo Lee
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sejoong Ahn
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Jonghak Park
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sungwoo Moon
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Hanjin Cho
- Department of Emergency Medicine, Korea University Ansan Hospital, Ansan-si, Republic of Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
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Karampela I, Kounatidis D, Vallianou NG, Panagopoulos F, Tsilingiris D, Dalamaga M. Kinetics of the Lactate to Albumin Ratio in New Onset Sepsis: Prognostic Implications. Diagnostics (Basel) 2024; 14:1988. [PMID: 39272772 PMCID: PMC11394523 DOI: 10.3390/diagnostics14171988] [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: 08/02/2024] [Revised: 09/03/2024] [Accepted: 09/06/2024] [Indexed: 09/15/2024] Open
Abstract
The lactate to albumin ratio (LAR) has been associated with the severity and outcome of critical illness and sepsis. However, there are no studies on the kinetics of the LAR during the early phase of sepsis. Therefore, we aimed to investigate the LAR and its kinetics in critically ill patients with new onset sepsis regarding the severity and outcome of sepsis. We prospectively enrolled 102 patients with sepsis or septic shock within 48 h from diagnosis. LARs were recorded at inclusion in the study and one week later. Patients were followed for 28 days. LAR was significantly lower one week after enrollment compared to baseline in all patients (p < 0.001). LARs were significantly higher in patients with septic shock and in nonsurvivors compared to patients with sepsis and survivors, respectively, both at inclusion (p < 0.001, p < 0.001) and at one week later (p < 0.001, p < 0.001). LARs at baseline were positively associated with the severity of sepsis (APACHE II: r = 0.29, p = 0.003; SOFA: r = 0.33, p < 0.001) and inflammatory biomarkers, such as C-reactive protein (r = 0.29, p < 0.1), procalcitonin (r = 0.47, p < 0.001), interleukin 6 (r = 0.28, p = 0.005) interleukin 10 (r = 0.3, p = 0.002) and suPAR (r = 0.28, p = 0.004). In addition, a higher LAR, but not its kinetics, was an independent predictor of 28-day mortality (at inclusion: HR 2.27, 95% C.I. 1.01-5.09, p = 0.04; one week later: HR: 4.29, 95% C.I. 1.71-10.78, p = 0.002). In conclusion, the LAR may be a valuable prognostic indicator in critically ill patients with sepsis at admission and one week later.
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Affiliation(s)
- Irene Karampela
- Second Department of Critical Care, Attikon General University Hospital, Medical School, National and Kapodistrian University of Athens, 1 Rimini St., Haidari, 12462 Athens, Greece
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias St., Goudi, 11527 Athens, Greece
| | - Dimitris Kounatidis
- Diabetes Center, First Department of Propaedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Natalia G Vallianou
- Department of Internal Medicine, Sismanogleio General Hospital, 1 Sismanogleiou St., 15126 Athens, Greece
| | - Fotis Panagopoulos
- Department of Internal Medicine, Sismanogleio General Hospital, 1 Sismanogleiou St., 15126 Athens, Greece
| | - Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias St., Goudi, 11527 Athens, Greece
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Chen Y, Ba J, Peng C, Peng H, Li S, Lai W. Impact of lactate/albumin ratio on prognostic outcomes in patients with concomitant heart failure and chronic kidney disease. Intern Emerg Med 2024; 19:1625-1636. [PMID: 38795274 DOI: 10.1007/s11739-024-03656-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/18/2024] [Indexed: 05/27/2024]
Abstract
Previous studies have linked the lactate/albumin (L/A) ratio to poor outcomes in various conditions, but its connection to mortality in patients with both heart failure (HF) and chronic kidney disease (CKD) remains unclear. Using data from 1537 patients in MIMIC-IV, this study examined the relationship between L/A ratio and in-hospital and one-year mortality, employing Cox models, Kaplan-Meier (KM) analysis, and restricted cubic splines (RCS). The non-survivor group showed higher L/A ratios than survivors (1.04 ± 0.78 vs. 0.58 ± 0.29, p < 0.001), indicating a significant link between higher L/A ratios and mortality. Cox analysis identified the L/A ratio was significantly related to all-cause mortality both in-hospital (HR 2.033; 95% CI 1.576-2.624; p < 0.001) and one-year (HR 1.723; 95% CI 1.428-2.078; p < 0.001). The association between L/A ratio and mortality was non-linear and increasing. The KM survival curves demonstrated significantly poorer survival outcomes for the high L/A group compared to the low L/A group, a difference that was statistically validated by a significant log-rank test (log-rank p < 0.001). L/A ratio has a significant association with poor prognosis in patients with HF and CKD patients in a critical condition. This finding demonstrates that L/A ratio might be useful in identifying patients with HF and CKD at high risk of all-cause death. Further large-scale prospective studies are needed to verify these results and inform clinical decisions.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Junhui Ba
- Department of Medical Intensive Care Unit, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chaoquan Peng
- Department of Cardiology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hui Peng
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China
| | - Shaomin Li
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China.
| | - Weiyan Lai
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-Sen University, Tianhe Road, Guangzhou, 510630, China.
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Sun H, Wang B, An G, Zhang Y, Ma L. Association of lactate/albumin ratio with 3-month readmission risk in heart failure patients: a retrospective study. ESC Heart Fail 2024; 11:2182-2190. [PMID: 38613427 PMCID: PMC11287303 DOI: 10.1002/ehf2.14788] [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: 02/02/2024] [Accepted: 03/15/2024] [Indexed: 04/15/2024] Open
Abstract
AIMS The predictive value of the lactate/albumin ratio (LAR) in mortality is established in various conditions, yet its relevance to 3-month readmission risk in Chinese adults with heart failure (HF) remains unclear. METHOD AND RESULTS Analysing data from 957 patients with HF at Zigong Fourth People's Hospital, Sichuan, China (December 2016 to June 2019), we assessed baseline characteristics, vital signs, comorbidities, and prescriptions. LAR demonstrated a linear correlation with 3-month readmission risk (HR = 1.60, 95% CI: 1.19-2.16). Tertile 3 (≥-0.48) exhibited higher risk than tertile 1 (<-0.83) and tertile 2 [-0.83, -0.48), with HRs and 95% CI of 1.49 (1.06-2.10), 1.43 (1.01-2.02), 1.48 (1.03-2.12), respectively. Subgroup and sensitivity analyses affirmed consistent influence of LAR on 3-month readmission risk for HF. CONCLUSIONS Higher LAR significantly correlates with increased 3-month readmission risk in Chinese adult patients with HF, suggesting LAR is a valuable predictor for early readmission.
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Affiliation(s)
- Hui Sun
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
- Department of Cardiology, Qilu Hospital (Qingdao)Qilu Hospital of Shandong UniversityQingdaoChina
| | - Baiqiang Wang
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Guipeng An
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Yun Zhang
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
| | - Lianyue Ma
- Department of Cardiology, National Key Laboratory for Innovation and Transformation of Luobing Theory, The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical SciencesQilu Hospital of Shandong UniversityJinanChina
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Chen Q, Zhan H, Chen J, Mo J, Huang S. Predictive value of lactate/albumin ratio for death and multiple organ dysfunction syndrome in patients with sepsis. J Med Biochem 2024; 43:617-625. [PMID: 39139160 PMCID: PMC11318848 DOI: 10.5937/jomb0-46947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/30/2023] [Indexed: 08/15/2024] Open
Abstract
Background Multiple organ dysfunction syndrome (MODS) is common after sepsis and increases mortality. Lactate (Lac) can assess the prognosis of patients. Albumin (Alb) is closely associated with inflammatory response in sepsis patients. This work evaluated the predictive value of Lac/Alb for prognosis of sepsis patients. Methods Data of 160 sepsis patients were retrospectively collected. Lac and Alb levels were measured upon admission, at 24 hours and 48 hours later. Using 0.45 as the cutoff value for Lac/Alb, patients were rolled into high-level (HL) and low-level (LL) groups. MODS rates and mortality rates were analyzed. Receiver operating characteristic (ROC) curves were utilized to evaluate the predictive value of 48-hour Lac/Alb for patient prognosis. Correlation between Lac/Alb and APACHE II and SOFA scores was assessed. Results The 12-month follow-up revealed 52 deaths (32.5%), and MODS occurred in 49 cases (30.6%) on the 7th day. The MODS group possessed elevated Lac and Lac/Alb and decreased Alb to the N-MODS group (P<0.05), and similar results were observed by comparison the survival and death group (P<0.05). The sensitivity, specificity, and area under the ROC curve (AUC) of Lac/Alb in predicting MODS were 81.63%, 85.59%, and 0.89, respectively, while those in predicting death were 94.23%, 88.89%, and 0.91, respectively. Lac/Alb was positively correlated with APACHE II and SOFA scores (r=0.718 and 0.808, respectively). Conclusions Lac/Alb was linked to MODS and mortality in sepsis patients and can be based to predict adverse outcomes.
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Affiliation(s)
- Qiuqiang Chen
- Central People's Hospital of Zhanjiang, Department of Second Ward of Intensive Care Medicine, Zhanjiang, Guangdong Province, China
| | - Haichao Zhan
- Central People's Hospital of Zhanjiang, Department of First Ward of Intensive Care Medicine, Zhanjiang, Guangdong Province, China
| | - Junyu Chen
- Central People's Hospital of Zhanjiang, Department of Second Ward of Intensive Care Medicine, Zhanjiang, Guangdong Province, China
| | - Junde Mo
- Central People's Hospital of Zhanjiang, Department of Second Ward of Intensive Care Medicine, Zhanjiang, Guangdong Province, China
| | - Shuwei Huang
- Central People's Hospital of Zhanjian, Department of Emergency, Zhanjiang, Guangdong Province, China
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Zhao X, Peng Q, Li W, Hu D, Guan Y, Wang J. Elevated lactate/albumin ratio is associated with poor prognosis in sepsis patients: A systematic review and meta-analysis. J Med Biochem 2024; 43:334-349. [PMID: 39139159 PMCID: PMC11318066 DOI: 10.5937/jomb0-42284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/03/2023] [Indexed: 08/15/2024] Open
Abstract
Background The aim of this study was to explore the association between lactate/albumin ratio and the prognosis of sepsis patients. Methods A computerized search was performed in Pubmed, EMbase, Ovid, Medline, and Google Scholar to collate relevant studies. The results were compared using standardized mean differences (SMD)/odds ratio (OR) and 95% confidence intervals (CI). Prospective and retrospective cohort studies were both included in this study.
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Affiliation(s)
- Xian Zhao
- Fourth Military Medical University, Xijing Hospital, Department of Pharmacy, Xi'an, China
| | - Qin Peng
- Fourth Military Medical University, Xijing Hospital, Department of Hepatobiliary Surgery, Xi'an, China
| | - Weiwei Li
- Fourth Military Medical University, Xijing Hospital, Department of Pharmacy, Xi'an, China
| | - Dongmei Hu
- Fourth Military Medical University, Xijing Hospital, Department of Pharmacy, Xi'an, China
| | - Yue Guan
- Fourth Military Medical University, Xijing Hospital, Department of Pharmacy, Xi'an, China
| | - Jingwen Wang
- Fourth Military Medical University, Xijing Hospital, Department of Pharmacy, Xi'an, China
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Nguyen Tat T, Vo Hoang-Thien N, Nguyen Tat D, Nguyen PH, Ho LT, Doan DH, Phan DT, Duong YNH, Nguyen TH, Nguyen TK, Dinh HTT, Dinh TTD, Pham ATM, Do Chau V, Trinh TH, Vo Thanh L. Prognostic values of serum lactate-to-bicarbonate ratio and lactate for predicting 28-day in-hospital mortality in children with dengue shock syndrome. Medicine (Baltimore) 2024; 103:e38000. [PMID: 38669370 PMCID: PMC11049702 DOI: 10.1097/md.0000000000038000] [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: 01/10/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
This study aimed to assess the clinical utility of blood lactate-to-bicarbonate (L/B) ratio, as a prognostic factor for 28-day in-hospital mortality in children with dengue shock syndrome (DSS), admitted to the pediatric intensive care unit (PICU). This single-center retrospective study was conducted at a tertiary children hospital in southern Vietnam from 2013 to mid-2022. Prognostic models for DSS mortality were developed, using a predefined set of covariates in the first 24 hours of PICU admission. Area under the curves (AUCs), multivariable logistic and Least Absolute Shrinkage and Selection Operator (LASSO) regressions, bootstrapping and calibration slope were performed. A total of 492 children with DSS and complete clinical and biomarker data were included in the analysis, and 26 (5.3%) patients died. The predictive values for DSS mortality, regarding lactate showing AUC 0.876 (95% CI, 0.807-0.944), and that of L/B ratio 0.867 (95% CI, 0.80-0.934) (P values of both biomarkers < .001). The optimal cutoff point of the L/B ratio was 0.25, while that of lactate was 4.2 mmol/L. The multivariable model showed significant clinical predictors of DSS fatality including severe bleeding, cumulative amount of fluid infused and vasoactive-inotropic score (>30) in the first 24 hours of PICU admission. Combined with the identified clinical predictors, the L/B ratio yielded higher prognostic values (odds ratio [OR] = 8.66, 95% confidence interval [CI], 1.96-38.3; P < .01) than the lactate-based model (OR = 1.35, 95% CI, 1.15-1.58; P < .001). Both the L/B and lactate models showed similarly good performances. Considering that the L/B ratio has a better prognostic value than the lactate model, it may be considered a potential prognostic biomarker in clinical use for predicting 28-day mortality in PICU-admitted children with DSS.
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Affiliation(s)
- Thanh Nguyen Tat
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | | | - Dat Nguyen Tat
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Medicine, Texila American University, Georgetown, Guyana
| | - Phuc Hoang Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Lien Thi Ho
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Duong Hung Doan
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Dung Tuan Phan
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | | | - Truc Huynh Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Tuyet Kim Nguyen
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Ha Thi-Thu Dinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Thuy Thi-Diem Dinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Anh Thi-Mai Pham
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Viet Do Chau
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Tung Huu Trinh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
| | - Luan Vo Thanh
- Department of Infectious Diseases, Children’s Hospital No.2, Ho Chi Minh City, Vietnam
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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.
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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.
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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.
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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
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11
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Şahin A, Bayrakçı S, Aslan S. An analysis of lactate/albumin, procalcitonin/albumin, and blood urea nitrogen/albumin ratios as a predictor of mortality in uroseptic patients. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20230422. [PMID: 37909614 PMCID: PMC10610782 DOI: 10.1590/1806-9282.20230422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/30/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the ratios of lactate/albumin, procalcitonin/albumin, and blood urea nitrogen/albumin to predict 14- and 28-day mortality in uroseptic patients. Urosepsis is a disease with high mortality, and early diagnosis and treatment are important. METHODS Patients with urosepsis who were admitted to the intensive care unit between January 2021 and September 2022, had a follow-up of at least 28 days, and met the inclusion criteria were evaluated retrospectively. RESULTS The mean age was 70.23 (15.66) years and 84 (53.85%) were males. The number of non-survivors were 75 (48%) in the 14-day mortality group and 97 (62.1%) in the 28-day mortality group. Based on the 14-day mortality data, the blood urea nitrogen/albumin ratio was higher in non-survivors vs. survivors (median, 15.88 vs. 9.62), and the lactate/albumin ratio was higher (median, 0.96 vs. 0.52, p<0.01, all). Based on the 28-day mortality data, the blood urea nitrogen/albumin ratio was higher in non-survivors vs. survivors (median, 14.78 vs. 8.46), and the lactate/albumin ratio was higher (median, 0.90 vs. 0.50, p<0.01, all). CONCLUSION It is very difficult to determine the prognosis of patients admitted to the emergency department with the diagnosis of urosepsis. The lactate/albumin ratio and the blood urea nitrogen/albumin ratio can be used as early prognostic markers for both 14-day and 28-day mortality until more reliable markers are identified.
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Affiliation(s)
- Ahmet Şahin
- Dr. Ersin Arslan Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology – Gaziantep, Turkey
| | - Sinem Bayrakçı
- Dr. Ersin Arslan Training and Research Hospital, Department of Intensive Care Unit – Gaziantep, Turkey
| | - Selda Aslan
- Dr. Ersin Arslan Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology – Gaziantep, Turkey
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Ren J, Kang Q, Wang F, Yu W. Association of lactate/albumin ratio with in-hospital mortality in ICU patients with acute respiratory failure: A retrospective analysis based on MIMIC-IV database. Medicine (Baltimore) 2023; 102:e35410. [PMID: 37773797 PMCID: PMC10545303 DOI: 10.1097/md.0000000000035410] [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: 04/11/2023] [Accepted: 09/05/2023] [Indexed: 10/01/2023] Open
Abstract
We aimed to investigate the association between the lactate/albumin ratio (LAR), and in-hospital mortality in critically ill patients with acute respiratory failure. This retrospective cohort study was conducted based on the medical information mart for intensive care-IV database, which included critically ill adult patients with acute respiratory failure whose primary endpoint was in-hospital death. The analyses included curve fitting, a logistic multivariate regression model, and subgroup analysis. In this study, 6028 intensive care unit patients with acute respiratory failure were analyzed. Of these, 1843 (30.57%) died. After adjusting for confounding factors, a nonlinear relationship between LAR and in-hospital mortality was observed, and the risk of death was found to decrease by 81% with a reduction of 1 unit of LAR when it was < 4.46. The association between LAR and in-hospital mortality was not statistically significant when LAR was > 4.46. Hence, the relationship between LAR and in-hospital mortality could only be observed when the LAR was < 4.46. There is a nonlinear relationship between LAR and the risk of in-hospital death in intensive care unit patients with acute respiratory failure, and there is a saturation effect.
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Affiliation(s)
- Jing Ren
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Quou Kang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Fangfang Wang
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
| | - Wencheng Yu
- Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Qingdao University, Qingdao, Shandong, People’s Republic of China
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Wang D, Luo C, Li Q, Zheng T, Gao P, Wang B, Duan Z. Association between lactate/albumin ratio and all-cause mortality in critical patients with acute myocardial infarction. Sci Rep 2023; 13:15561. [PMID: 37730950 PMCID: PMC10511737 DOI: 10.1038/s41598-023-42330-8] [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: 06/04/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
It has been demonstrated that lactate/albumin (L/A) ratio is substantially relevant to the prognosis of sepsis, septic shock, and heart failure. However, there is still debate regarding the connection between the L/A ratio and severe acute myocardial infarction (AMI). The aim of this study is to determine the prognostic role of L/A ratio in patients with severe AMI. Our retrospective study extracted data from the Medical Information Mart for Intensive Care III (MIMIC-III) database, included 1,134 patients diagnosed with AMI. Based on the tertiles of L/A ratio, the patients were divided into three groups: Tertile1 (T1) group (L/A ratio<0.4063, n=379), Tertile2 (T2) group (0.4063≤L/A ratio≤0.6667, n =379), and Tertile3 (T3) group (L/A ratio>0.6667, n =376). Uni- and multivariate COX regression model were used to analyze the relationship between L/A ratio and 14-day, 28-day and 90-day all-cause mortality. Meanwhile, the restricted cubic spline (RCS) model was used to evaluate the effect of L/A ratio as a continuous variable. Higher mortality was observed in AMI patients with higher L/A ratio. Multivariate Cox proportional risk model validated the independent association of L/A ratio with 14-day all-cause mortality [hazard ratio (HR) 1.813, 95% confidence interval (CI) 1.041-3.156 (T3 vs T1 group)], 28-day all-cause mortality [HR 1.725, 95% CI 1.035-2.874 (T2 vs T1 group), HR 1.991, 95% CI 1.214-3.266 (T3 vs T1 group)], as well as 90-day all-cause mortality [HR 1.934, 95% CI 1.176-3.183 (T2 vs T1 group), HR 2.307, 95% CI 1.426-3.733 (T3 vs T1 group)]. There was a consistent trend in subgroup analysis. The Kaplan-Meier (K-M) survival curves indicated that patients with L/A ratio>0.6667 had the highest mortality. Even after adjusting the confounding factors, RCS curves revealed a nearly linearity between L/A ratio and 14-day, 28-day and 90-day all-cause mortality. Meanwhile, the areas under the receiver operating characteristic (ROC) curve (AUC) of 14-day, 28-day and 90-day all-cause mortality were 0.730, 0.725 and 0.730, respectively. L/A ratio was significantly associated with 14-day, 28-day and 90-day all-cause mortality in critical patients with AMI. Higher L/A ratio will be considered an independent risk factor for higher mortality in AMI patients.
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Affiliation(s)
- Danni Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Chaodi Luo
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Qian Li
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Tingting Zheng
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Pengjie Gao
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Boxiang Wang
- Department of Cardiology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Zhenzhen Duan
- Department of Peripheral Vascular Diseases, Honghui Hospital of Xi'an Jiaotong University, 555 Youyi East Road, Xi'an, People's Republic of China.
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Chen S, Guan S, Yan Z, Ouyang F, Li S, Liu L, Zhong J. The lactate to albumin ratio linked to all-cause mortality in critically ill patients with septic myocardial injury. Front Cardiovasc Med 2023; 10:1233147. [PMID: 37790597 PMCID: PMC10542581 DOI: 10.3389/fcvm.2023.1233147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/04/2023] [Indexed: 10/05/2023] Open
Abstract
Background The lactate to albumin ratio (LAR) has emerged as a promising prognostic marker in critically ill patients. Despite its potential utility, the prognostic value of LAR in septic myocardial injury (SMI) remains uncertain. Methods This study aims to investigate the prognostic significance of LAR in SMI through a retrospective cohort analysis of data from the Medical Information Mart for Intensive Care III (MIMIC-III) (v1.4) database. The study included intensive care unit (ICU)-admitted patients (age ≥18 years) diagnosed with SMI. The primary endpoint was in-hospital mortality. Results A total of 704 patients were included in the study, of which 59.10% were male. Hospital mortality and ICU mortality rates were recorded at 29.97% and 22.87%, respectively. After adjusting for confounding factors, multivariate Cox proportional risk analysis demonstrated that LAR was independently associated with an increased risk of both hospital mortality (HR, 1.39 [95% CI: 1.24-1.56] P < 0.001) and ICU mortality (HR, 1.46 [95% CI: 1.29-1.65] P < 0.001). Furthermore, the generalized additive model (GAM) and restricted cubic spline (RCS) model indicated a linear relationship between LAR and mortality rates in the ICU and hospital. Conclusions The LAR may serve as a potential prognostic biomarker in critically ill patients with SMI. High LAR levels are associated with a higher risk of in-hospital mortality and can help identify individuals with high mortality rates. Overall, the findings emphasize the importance of using LAR as a tool for risk stratification and management of critically ill patients with SMI.
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Affiliation(s)
- Sheng Chen
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Senhong Guan
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Zhaohan Yan
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Fengshan Ouyang
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Foshan, China
| | - Shuhuan Li
- Department of Pediatrics, Shunde Hospital, Southern Medical University, Foshan, China
| | - Lanyuan Liu
- Department of Ultrasound Medicine, Shunde Hospital, Southern Medical University, Foshan, China
| | - Jiankai Zhong
- Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China
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15
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Ray CC, Pollack MM, Gai J, Patel AK. The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients. Pediatr Crit Care Med 2023; 24:760-766. [PMID: 37171215 PMCID: PMC10523881 DOI: 10.1097/pcc.0000000000003272] [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] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients. DESIGN Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database. SETTING U.S. hospitals with PICUs. PATIENTS Children admitted to the ICU ( n = 648) from 2009 to 2018 who had lactate and albumin measured within 6 hours of admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 648 admissions were included, with an overall mortality rate of 10.8% ( n = 70) and a MODS prevalence of 29.3% ( n = 190). Compared with survivors, deaths had higher initial lactates (7.3 mmol/L [2.6-11.7 mmol/L] vs 1.9 mmol/L [1.2-3.1 mmol/L]; p < 0.01), lower initial albumins (3.3 g/dL [2.7-3.8 g/dL] vs 4.2 g/dL [3.7-4.7 g/dL]; p < 0.01), and higher LARs (2.2 [1.0-4.2] vs 0.5 [0.3-0.8]; p < 0.01), with similar trends in patients with MODS versus those without MODS. LAR demonstrated a higher odds ratio (OR) for death than initial lactate alone (2.34 [1.93-2.85] vs 1.29 [1.22-1.38]) and a higher OR for MODS than initial lactate alone (2.10 [1.73-2.56] vs 1.22 [1.16-1.29]). Area under the receiver operating characteristic (AUROC) curve of LAR for mortality was greater than initial lactate (0.86 vs 0.82; p < 0.01). The LAR AUROC for MODS was greater than the lactate AUROC (0.71 vs 0.66; p < 0.01). Trends of lactate, albumin, and LAR for mortality were consistent across several diagnostic subgroups (trauma, primary respiratory failure, toxicology), but not all. CONCLUSIONS LAR measured early in the course of critical illness is significantly associated with mortality and development of MODS when compared with initial lactate or initial albumin alone in critically ill pediatric patients.
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Affiliation(s)
- Christopher C Ray
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC
| | - Murray M Pollack
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jiaxiang Gai
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Anita K Patel
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
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Butt W. The Lactate-Albumin Ratio Predicts Multiple Organ Dysfunction Syndrome and Death, But Is It Ready to Use? Pediatr Crit Care Med 2023; 24:785-787. [PMID: 37668501 DOI: 10.1097/pcc.0000000000003317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Warwick Butt
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Faculty of Medicine, Melbourne University, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
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17
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Chen Y, Yang K, Wu B, Lin W, Chen S, Xu X, Peng C, Xie D. Association between lactate/albumin ratio and mortality in patients with heart failure after myocardial infarction. ESC Heart Fail 2023; 10:1928-1936. [PMID: 36987543 PMCID: PMC10192240 DOI: 10.1002/ehf2.14359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/02/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
AIMS Lactate/albumin ratio (L/A) is a recognized prognostic index of patients with heart failure (HF) after myocardial infarction (MI). We aim to evaluate the prognostic value of L/A ratio in predicting in-hospital mortality for those patients. METHODS AND RESULTS We enrolled qualified patients from Medical Information Mart for Intensive Care IV database for retrospective study. A receiver operating characteristic (ROC) curve of the subjects was applied to determine the predicted value and the best cut-off value of L/A on admission. Univariate/multivariate Cox regression analysis and restricted cubic splines (RCS) were performed to identify the association between hospital admission and hospital mortality. The Kaplan-Meier (KM) method was used to draw the survival curve of the two groups with different L/A levels at admission. L/A values at admission were significantly higher in the death groups than the survival groups [1.36 (1.20) vs. 0.62 (0.36), P < 0.05], and area under the ROC curve [0.780 (95% confidence interval, 0.772-0.827)] was better than other indicators, and the best the cut-off value was 0.671. 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 <0.05). KM survival curves were significantly lower in the high L/A group than the low L/A group (P < 0.001), and the former group had an increased risk of in-hospital mortality compared with the latter one (log rank P < 0.001). CONCLUSIONS Elevated L/A ratio on admission is an independent predictor of high in-hospital mortality in post-MI heart failure patients, which proved to be better than lactate, Sequential Organ Failure Assessment score and other related indicators.
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Affiliation(s)
- Yang Chen
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Ke Yang
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Bingyuan Wu
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Wanwen Lin
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Simin Chen
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Xiaochun Xu
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Chaoquan Peng
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
| | - Dongmei Xie
- Department of Cardiology, Third Affiliated HospitalSun Yat‐sen UniversityTianhe RoadGuangzhouGuangdong510630China
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18
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Xu C, Liu H, Zhang H, Zeng J, Li Q, Yi Y, Li N, Cheng R, Li Q, Zhou X, Lv C. Predictive value of arterial blood lactate to serum albumin ratio for in-hospital mortality of patients with community-acquired pneumonia admitted to the Intensive Care Unit. Postgrad Med 2023; 135:273-282. [PMID: 35930266 DOI: 10.1080/00325481.2022.2110769] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To investigate the predictive value of the arterial blood lactate to serum albumin ratio (LAR) on in-hospital mortality of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU). METHODS Clinical datasets of 1720 CAP patients admitted to ICU from MIMIC-IV database were retrospectively analyzed. Patients were randomly assigned to the training cohort (n=1204) and the validation cohort (n=516) in a ratio of 7:3. X-tile software was used to find the optimal cut-off value for LAR. The receiver operating curve (ROC) analysis was conducted to compare the performance between LAR and other indicators. Univariate and multivariate Cox regression analyses were applied to select prognostic factors associated with in-hospital mortality. Based on the observed prognostic factors, a nomogram model was created in training cohort, and the validation cohort was utilized to further validate the nomogram. RESULTS The optimal cut-off value for LAR in CAP patients admitted to ICU was 1.6 (the units of lactate and albumin were, respectively, 'mmol/L' and 'g/dL'). The ROC analysis showed that the discrimination abilities of LAR were superior to other indicators except Sequential Organ Failure Assessment score and Simplified acute physiology score (SAPSII), which had the same abilities. Age, mean arterial pressure, SpO2, heart rate, SAPSII score, neutrophil-to-lymphocyte ratio, and LAR were found to be independent predictors of poor overall survival in the training cohort by multivariate Cox regression analysis and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram model, exhibiting medium discrimination, had a C-index of 0.746 (95% CI = 0.715-0.777) in the training cohort and 0.716 (95% CI = 0.667-0.765) in the validation cohort. CONCLUSION LAR could predict in-hospital mortality of patients with CAP admitted to ICU independently as a readily accessible biomarker. The nomogram that included LAR with other independent factors performed well in predicting in-hospital mortality.
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Affiliation(s)
- Chaoqun Xu
- Emergency and Trauma College, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Haoran Liu
- Emergency and Trauma College, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Hao Zhang
- Department of Emergency, The Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Jun Zeng
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Quan Li
- Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Yi
- Emergency and Trauma College, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Nan Li
- Emergency and Trauma College, Hainan Medical University, Haikou, China
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
| | - Ruxin Cheng
- Emergency and Trauma College, Hainan Medical University, Haikou, China
| | - Qi Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiangdong Zhou
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China
| | - Chuanzhu Lv
- Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China
- Emergency Medicine Center, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
- Research Unit of Island Emergency Medicine, Chinese Academy of Medical Sciences (No. 2019RU013), Hainan Medical University, Haikou, China
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Kabra R, Acharya S, Shukla S, Kumar S, Wanjari A, Mahajan S, Gaidhane SA, Bhansali PJ, Wasnik P. Serum Lactate-Albumin Ratio: Soothsayer for Outcome in Sepsis. Cureus 2023; 15:e36816. [PMID: 37123772 PMCID: PMC10146386 DOI: 10.7759/cureus.36816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 03/28/2023] [Indexed: 03/29/2023] Open
Abstract
AIM The aim of this study is to assess the efficacy of the serum lactate/albumin (L/A) ratio as a prognostic marker of sepsis syndrome. MATERIALS AND METHODS This study was conducted in the Internal Medicine Department at Acharya Vinoba Bhave Rural Hospital with a sample size of 160 cases of sepsis. The serum L/A ratio was calculated on admission and correlated with deaths and morbidity. Statistical analysis was significant if the P-value was less than 0.05. RESULTS The mean age of patients was 52.83 ± 16.80 years with a male predominance (64.4% vs. 35.6%). The mean L/A ratio was 0.95 ± 0.46. The proportion of discharged subjects and mortality were 58.8% and 41.2%, respectively. The study found that a higher mean L/A ratio (1.1-1.44) was significantly linked to the various variables in the study. Furthermore, a significantly higher median L/A ratio of 1.23 was found in subjects with vasopressor use. The median L/A ratio in the Discharge group and Death group was 0.64 and 1.27, respectively. The area under the receiver operating characteristic (AUROC) curve indicated that accurate diagnostic performance was 0.976 in predicting Death versus Discharge for the L/A ratio. CONCLUSION This study found that, compared to lactate and albumin alone, the predictor value of the L/A ratio was outstanding in predicting death and hospital stay (discharge) among sepsis participants, with a sensitivity of 100% and a specificity of 88%.
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Durak C, Sahin EG, Can YY, Sarisaltik A, Guvenc KB. The value of prognostic markers for pediatric trauma patients. World J Emerg Med 2023; 14:448-453. [PMID: 37969210 PMCID: PMC10632752 DOI: 10.5847/wjem.j.1920-8642.2023.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/10/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Despite the rapid development of pediatric intensive care medicine, there are still limited data in the literature regarding the follow-up of pediatric trauma patients in pediatric intensive care units (PICUs). In this study, we aim to evaluate our experience with children admitted and followed up with the diagnosis of trauma at our PICU. METHODS We evaluated the retrospective data of 77 pediatric trauma patients who were admitted to the PICU at Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital from August 2020 to December 2022. The demographic data, clinical parameters and laboratory results were recorded. The primary outcome was the mortality in PICU. The performances of markers in predicting mortality were evaluated with receiver operating characteristic (ROC) curves. RESULTS The median age of the patients was 70 (33-157) months, and the median duration of hospitalization in the PICU was 6 (2-11) d. Of the 77 patients, 9 died due to trauma (11,1%). Among the clinical parameters, Pediatric Risk of Mortality III (PRISM III) Score, inotrope requirement, extracorporeal treatment requirement, and mechanical ventilator requirement were significantly higher in non-survivors than in survivors. Among the laboratory parameters, procalcitonin (PCT), lactate/albumin ratio (LAR), neutrophil/lymphocyte ratio (NLR), and transfusion requirement were significantly higher in non-survivors than in survivors. CONCLUSION In pediatric trauma patients, baseline PCT, LAR, and NLR values can be used to identify patients at risk for mortality.
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Affiliation(s)
- Cansu Durak
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Ebru Guney Sahin
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Yasar Yusuf Can
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
| | - Alican Sarisaltik
- Republic of Türkiye Ministry of Health, Cayirova District Health Directorate, Kocaeli 41420, Türkiye
| | - Kubra Boydag Guvenc
- Department of Pediatric Intensive Care, Sancaktepe Sehit Prof. Dr. IlhanVarank Training and Research Hospital, Health Science University, Istanbul 34785, Türkiye
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21
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Wang G, Liu J, Xu R, Fu Y, Liu X. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children. BMC Pediatr 2022; 22:725. [PMID: 36539725 PMCID: PMC9764537 DOI: 10.1186/s12887-022-03787-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Managing critically ill patients with high mortality can be difficult for clinicians in pediatric intensive care units (PICU), which need to identify appropriate predictive biomarkers. The lactate/albumin (L/A) ratio can precisely stratify critically ill adults. However, the role of the L/A ratio in predicting the outcomes of critically ill children remains unclear. Therefore, this study aimed to evaluate the prognostic performance of the L/A ratio in predicting in-hospital mortality in unselected critically ill patients in the PICU. METHODS This was a single-center retrospective study. Clinical data of 8,832 critical patients aged between 28 days and 18 years were collected from the pediatric intensive care (PIC) database from 2010 to 2018. The primary outcome was the in-hospital mortality rate. RESULTS There was a higher level of L/A ratio in non-survivors than survivors (P < 0.001). Logistic regression indicated that the association between the L/A ratio and in-hospital mortality was statistically significant (OR 1.44, 95% CI 1.31-1.59, P < 0.001). The AUROC of the L/A ratio for predicting in-hospital mortality was higher than lactate level alone (0.74 vs 0.70, P < 0.001). Stratification analysis showed a significant association between the L/A ratio and in-hospital mortality in the age and primary disease groups (P < 0.05). CONCLUSIONS Our study suggested that the L/A ratio was a clinical tool to predict in-hospital mortality in critically ill children better than lactate level alone. However, given that the study was retrospective, more prospective studies should be conducted to test the predictive value of the L/A ratio in critical illness.
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Affiliation(s)
- Guan Wang
- grid.452402.50000 0004 1808 3430Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, 250012 Jinan, Shandong Province China
| | - Junhui Liu
- grid.452402.50000 0004 1808 3430Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, 250012 Jinan, Shandong Province China
| | - Rui Xu
- grid.452402.50000 0004 1808 3430Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, 250012 Jinan, Shandong Province China
| | - Yanan Fu
- grid.452402.50000 0004 1808 3430Department of Medical Engineering, Qilu Hospital of Shandong University, No.107 West Wenhua Road, 250012 Jinan, Shandong Province China
| | - Xinjie Liu
- grid.452402.50000 0004 1808 3430Department of Pediatrics, Qilu Hospital of Shandong University, No.107 West Wenhua Road, 250012 Jinan, Shandong Province China
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22
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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.
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23
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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.
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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
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24
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Soffer S, Zimlichman E, Levin MA, Zebrowski AM, Glicksberg BS, Freeman R, Reich DL, Klang E. Machine learning to predict in-hospital mortality among patients with severe obesity: Proof of concept study. Obes Sci Pract 2022; 8:474-482. [PMID: 35949284 PMCID: PMC9358726 DOI: 10.1002/osp4.571] [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: 06/29/2021] [Revised: 09/25/2021] [Accepted: 10/01/2021] [Indexed: 11/22/2022] Open
Abstract
Objectives Hospitalized patients with severe obesity require adapted hospital management. The aim of this study was to evaluate a machine learning model to predict in-hospital mortality among this population. Methods Data of unselected consecutive emergency department admissions of hospitalized patients with severe obesity (BMI ≥ 40 kg/m2) was analyzed. Data was retrieved from five hospitals from the Mount Sinai health system, New York. The study time frame was between January 2011 and December 2019. Data was used to train a gradient-boosting machine learning model to identify in-hospital mortality. The model was trained and evaluated based on the data from four hospitals and externally validated on held-out data from the fifth hospital. Results A total of 14,078 hospital admissions of inpatients with severe obesity were included. The in-hospital mortality rate was 297/14,078 (2.1%). In univariate analysis, albumin (area under the curve [AUC] = 0.77), blood urea nitrogen (AUC = 0.76), acuity level (AUC = 0.73), lactate (AUC = 0.72), and chief complaint (AUC = 0.72) were the best single predictors. For Youden's index, the model had a sensitivity of 0.77 (95% CI: 0.67-0.86) with a false positive rate of 1:9. Conclusion A machine learning model trained on clinical measures provides proof of concept performance in predicting mortality in patients with severe obesity. This implies that such models may help to adopt specific decision support tools for this population.
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Affiliation(s)
- Shelly Soffer
- Internal Medicine BAssuta Medical CenterAshdodIsrael
- Ben‐Gurion University of the NegevBe’er ShevaIsrael
| | - Eyal Zimlichman
- Hospital ManagementSheba Medical CenterTel HashomerIsrael
- Sackler Medical SchoolTel Aviv UniversityTel AvivIsrael
- Sheba Talpiot Medical Leadership ProgramTel HashomerIsrael
| | - Matthew A. Levin
- Department of Population Health Science and PolicyInstitute for Healthcare Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Anesthesiology, Perioperative and Pain MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alexis M. Zebrowski
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Population Health Science and PolicyInstitute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Benjamin S. Glicksberg
- Hasso Plattner Institute for Digital Health at Mount SinaiIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Robert Freeman
- Department of Population Health Science and PolicyInstitute for Healthcare Delivery ScienceIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David L. Reich
- Department of Anesthesiology, Perioperative and Pain MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Eyal Klang
- Sackler Medical SchoolTel Aviv UniversityTel AvivIsrael
- Sheba Talpiot Medical Leadership ProgramTel HashomerIsrael
- Department of Diagnostic ImagingSheba Medical CenterTel HashomerIsrael
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Comparison of lactate/albumin ratio to lactate and lactate clearance for predicting outcomes in patients with septic shock admitted to intensive care unit: an observational study. Sci Rep 2022; 12:13047. [PMID: 35906231 PMCID: PMC9338032 DOI: 10.1038/s41598-022-14764-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/13/2022] [Indexed: 11/08/2022] Open
Abstract
The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918-0.987, P < 0.001), (AUC 0.917, 95% CI 0.861-0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845-0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.
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Wang R, He M, Qu F, Zhang J, Xu J. Lactate Albumin Ratio Is Associated With Mortality in Patients With Moderate to Severe Traumatic Brain Injury. Front Neurol 2022; 13:662385. [PMID: 35432157 PMCID: PMC9011050 DOI: 10.3389/fneur.2022.662385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a serious public health issue all over the world. This study was designed to evaluate the prognostic value of lactate to albumin ratio (LAR) on patients with moderate to severe TBI. Methods Clinical data of 273 moderate to severe TBI patients hospitalized in West China Hospital between May 2015 and January 2018 were collected. Multivariate logistic regression analyses were used to explore risk factors and construct a prognostic model of in-hospital mortality in this cohort. A receiver operating characteristic (ROC) curve was drawn to evaluate the discriminative ability of this model. Results Non-survivors had higher LAR than survivors (1.09 vs. 0.53, p < 0.001). Results of multivariate logistic regression analysis showed that Glasgow Coma Scale (GCS; odds ratio [OR] = 0.743, p = 0.001), blood glucose (OR = 1.132, p = 0.005), LAR (OR = 1.698, p = 0.022), subdural hematoma (SDH; OR = 2.889, p = 0.006), intraparenchymal hemorrhage (IPH; OR = 2.395, p = 0.014), and diffuse axonal injury (DAI; OR = 2.183, p = 0.041) were independent risk factors of in-hospital mortality in included patients. These six factors were utilized to construct the prognostic model. The area under the ROC curve (AUC) values of single lactate, albumin, and LAR were 0.733 (95% Cl; 0.673–0.794), 0.740 (95% Cl; 0.683–0.797), and 0.780 (95% Cl; 0.725–0.835), respectively. The AUC value of the prognostic model was 0.857 (95%Cl; 0.812–0.901), which was higher than that of LAR (Z = 2.1250, p < 0.05). Conclusions Lactate to albumin ratio is a readily available prognostic marker of moderate to severe TBI patients. A prognostic model incorporating LAR is beneficial for clinicians to evaluate possible progression and make treatment decisions in TBI patients.
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Affiliation(s)
- Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Min He
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Min He
| | - Fengyi Qu
- Department of Radiation Oncolygy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jing Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
- Jianguo Xu
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Feng A, Ao X, Zhou N, Huang T, Li L, Zeng M, Lyu J. A Novel Risk-Prediction Scoring System for Sepsis among Patients with Acute Pancreatitis: A Retrospective Analysis of a Large Clinical Database. Int J Clin Pract 2022; 2022:5435656. [PMID: 35685488 PMCID: PMC9159144 DOI: 10.1155/2022/5435656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Background The prognosis is poor when acute pancreatitis (AP) progresses to sepsis; therefore, it is necessary to accurately predict the probability of sepsis and develop a personalized treatment plan to reduce the disease burden of AP patients. Methods A total of 1295 patients with AP and 43 variables were extracted from the Medical Information Mart for Intensive Care (MIMIC) IV database. The included patients were randomly assigned to the training set and to the validation set at a ratio of 7 : 3. The chi-square test or Fisher's exact test was used to test the distribution of categorical variables, and Student's t-test was used for continuous variables. Multivariate logistic regression was used to establish a prognostic model for predicting the occurrence of sepsis in AP patients. The indicators to verify the overall performance of the model included the area under the receiver operating characteristic curve (AUC), calibration curves, the net reclassification improvement (NRI), the integrated discrimination improvement (IDI), and a decision curve analysis (DCA). Results The multifactor analysis results showed that temperature, phosphate, calcium, lactate, the mean blood pressure (MBP), urinary output, Glasgow Coma Scale (GCS), Charlson Comorbidity Index (CCI), sodium, platelet count, and albumin were independent risk factors. All of the indicators proved that the prediction performance and clinical profitability of the newly established nomogram were better than those of other common indicators (including SIRS, BISAP, SOFA, and qSOFA). Conclusions The new risk-prediction system that was established in this research can accurately predict the probability of sepsis in patients with acute pancreatitis, and this helps clinicians formulate personalized treatment plans for patients. The new model can reduce the disease burden of patients and can contribute to the reasonable allocation of medical resources, which is significant for tertiary prevention.
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Affiliation(s)
- Aozi Feng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Xi Ao
- The Science & Education Office, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510632, China
| | - Ning Zhou
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Li Li
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
| | - Mengnan Zeng
- College of Pharmacy, Henan University of Chinese Medicine, Zhengzhou, Henan 450046, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510632, China
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Prognostic value of the lactate–albumin difference for predicting in-hospital mortality in critically ill patients with sepsis. MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1059093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Erdoğan M, Findikli HA. Prognostic value of the lactate/albumin ratio for predicting mortality in patients with pneumosepsis in intensive care units. Medicine (Baltimore) 2022; 101:e28748. [PMID: 35089251 PMCID: PMC8797532 DOI: 10.1097/md.0000000000028748] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 01/08/2022] [Indexed: 01/05/2023] Open
Abstract
The lactate/albumin (L/A) ratio correlates with Acute Physiology and Chronic Health Evaluation 2 (APACHE-2) and Sequential Organ Failure Assessment (SOFA) scores. This study examined whether the L/A ratio has prognostic value in a larger group of critically ill (adult) patients admitted to an intensive care unit (ICU) due to pneumosepsis.This retrospective study analyzed the data of 273 patients with pneumosepsis admitted to the Internal Medicine ICU of Adana City Training and Research Hospital between 2018 and 2020. Patients diagnosed with pneumosepsis were included in the study. The data were obtained from the hospital system. Patients who had cancer, who were pregnant, and patients whose necessary data could not obtain for the study were excluded from the study.The L/A ratio was superior to lactate or albumin alone as a predictor of mortality. Furthermore, this result was valid for patients with kidney and hepatic dysfunction. A correlation occurred between the L/A ratio and APACHE-2 and SOFA scores in patients with pneumosepsis.The L/A ratio can be an independent predictor of mortality in patients with pneumosepsis and patients with pneumosepsis with renal and hepatic dysfunction. The L/A ratio correlated positively with lactate levels and APACHE-2 and SOFA scores but negatively with albumin levels.
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Affiliation(s)
- Murat Erdoğan
- Department of Internal Medicine Intensive Care Unit, University of Health Sciences - Adana Health Practice and Research Center, Adana, Turkey
| | - Hüseyin Avni Findikli
- Department of Internal Medicine, Kahramanmaraş Necip Fazil City Hospital, Kahramanmaraş, Turkey
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Zhu X, Xue J, Liu Z, Dai W, Xu H, Zhou Q, Zhao S, Zhou Q, Chen W. The Lactate/Albumin Ratio Predicts Mortality in Critically Ill Patients with Acute Kidney Injury: An Observational Multicenter Study on the eICU Database. Int J Gen Med 2022; 14:10511-10525. [PMID: 35002307 PMCID: PMC8722580 DOI: 10.2147/ijgm.s339767] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/07/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The serum lactate/albumin ratio (LAR) can be used to independently predict mortality due to sepsis. However, whether the LAR predicts the outcomes of critically ill patients with acute kidney injury (AKI) remains unclear. This study was performed to assess the prognostic value of the LAR in critically ill AKI patients. METHODS This retrospective observational study enrolled AKI patients, and all data were collected through the eICU Collaborative Research Database. Outcomes included in-hospital and intensive care unit (ICU) death. Multivariate Cox regression analysis was used to determine independent risk factors. Forest plots and smoothing curves were generated. A series of subgroup analyses were performed to further validate the robustness of the findings. RESULTS A total of 4666 eligible patients were enrolled. We divided the participants into four groups according to the LAR: quartile (Q)1 (LAR < 0.46, n = 1167), Q2 (0.46 ≤ LAR < 0.79, n = 1162), Q3 (0.79 ≤ LAR < 1.49, n = 1170), and Q4 (LAR ≥ 1.49, n = 1167). The LAR, when analyzed as a continuous variable, was associated with hospital and ICU mortality (adjusted hazard ratio [HR] 1.22, 95% confidence interval [CI] 1.18-1.26, P < 0.0001 for both). The risk of in-hospital and ICU mortality increased with increasing LAR Q relative to Q1. The smoothing curves revealed a continuous linear association after adjusting for all covariates. By the Kaplan-Meier analysis, patients in the higher LAR group showed significantly shorter survival time. By the receiver operating characteristic analysis, LAR was efficient in predicting in-hospital mortality (area under the curve [AUC]: 0.717) and ICU mortality (AUC: 0.733). A positive and consistent effect of the LAR was seen in all subgroups analyses after adjusting for all covariates. CONCLUSION A high LAR is an independent risk factor for in-hospital and ICU mortality in critically ill patients with AKI. Further prospective studies are needed to validate these result.
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Affiliation(s)
- Xu Zhu
- Department of Epidemiology and Health Statistics, College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, 410208, People's Republic of China
| | - Jing Xue
- Department of Scientific Research, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Zheng Liu
- Department of Anesthesiology, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated with Shandong First Medical University, Ji'nan, Shandong, 250014, People's Republic of China
| | - Wenjie Dai
- Xiangya School of Public Health, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Hui Xu
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Qiaoling Zhou
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Shuangping Zhao
- Department of Intensive Care Unit, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Quan Zhou
- Department of Science and Education, The First People's Hospital of Changde City, Changde, Hunan, 415000, People's Republic of China
| | - Wenhang Chen
- Department of Nephrology, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
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Dudoignon E, Quennesson T, De Tymowski C, Moreno N, Coutrot M, Chaussard M, Guillemet L, Abid S, Fratani A, Ressaire Q, Cupaciu A, Weinmann V, Pharaboz A, Benyamina M, Mebazaa A, Legrand M, Depret F, Deniau B. Usefulness of lactate albumin ratio at admission to predict 28-day mortality in critically ill severely burned patients: A retrospective cohort study. Burns 2022; 48:1836-1844. [PMID: 35012801 DOI: 10.1016/j.burns.2022.01.003] [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: 05/25/2021] [Revised: 11/19/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Lactate albumin ratio (LAR) has been used as a prognostic marker associated with organ failure in critically ill septic patients. LAR and its association with outcomes has never been studied in burned patients. The aim of this study was to evaluate the ability of LAR to predict 28-day mortality. METHODS A retrospective cohort study including all burn patients hospitalized in intensive care unit. The primary endpoint was the 28-day mortality. RESULTS One thousand three hundred thirty four patients were screened, and 471 were included between June 2012 and December 2018. Briefly, the population study was mainly composed by men (249, 59.1%), the median age, TBSA burned, full thickness, ABSI and IGS2 were 52 [34-68], 20 [10-40], 8 [1-23], 7 [5-9] and 25 [15-40] respectively. Fifty-two patients (12.4%) died at day 28 after admission. At admission, the LAR level was lower in 28-day survivors compared non-survivors (0.05 [0.04, 0.08] vs 0.12 [0.07, 0.26], p < 0.001 respectively). In multivariate analysis accounting for ABSI, LAR levels at admission> 0.13 was independently associated with 28-day mortality (adjusted OR = 3.98 (IC95 1.88-8.35)). The ability of LAR at admission to discriminate 28-day mortality showed an AUC identical when compared to SOFA and ABSI scores (0.81 (IC95 0.74-0.88), 0.80 (IC95 0.72-0.85) and (0.85 (IC95 0.80-0.90), p < 0.05, respectively). Patients with LAR levels ≥ 0.13 at admission had higher 28-day mortality (40.6% vs 6.8%, p < 0.001, HR 7.39 (IC95 4.28-12.76)). CONCLUSION At admission, LAR is an easy and reliable marker independently associated to 28-day mortality in patients with severe burn injury, but prediction by LAR does not perform better than lactate level alone.
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Affiliation(s)
- Emmanuel Dudoignon
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France; FHU PROMICE, Paris, France.
| | - Thomas Quennesson
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Christian De Tymowski
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France
| | - Nabila Moreno
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Biochemistry Laboratory, Paris, France
| | - Maxime Coutrot
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Maïté Chaussard
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Lucie Guillemet
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Sonia Abid
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Alexandre Fratani
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Quentin Ressaire
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France
| | - Alexandru Cupaciu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Vagh Weinmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Alexandre Pharaboz
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Mourad Benyamina
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France
| | - Alexandre Mebazaa
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France; INI-CRCT Network, Nancy, France; FHU PROMICE, Paris, France
| | - Matthieu Legrand
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France; INI-CRCT Network, Nancy, France; Department of Anaesthesiology and Peri-operative Medicine and Critical Care Medicine, University of California, San Francisco, CA, USA
| | - François Depret
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France; INI-CRCT Network, Nancy, France; FHU PROMICE, Paris, France
| | - Benjamin Deniau
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anesthesiology and Critical Care and Burn Unit, Paris, France; University Paris Diderot, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM UMR-S 942 Mascot, Lariboisière Hospital, Paris, France; FHU PROMICE, Paris, France
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Clinical Usefulness of Red Cell Distribution Width/Albumin Ratio to Discriminate 28-Day Mortality in Critically Ill Patients with Pneumonia Receiving Invasive Mechanical Ventilation, Compared with Lacate/Albumin Ratio: A Retrospective Cohort Study. Diagnostics (Basel) 2021; 11:diagnostics11122344. [PMID: 34943582 PMCID: PMC8699932 DOI: 10.3390/diagnostics11122344] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/25/2021] [Accepted: 12/09/2021] [Indexed: 12/15/2022] Open
Abstract
The value of the red cell distribution width (RDW) is associated with prognosis in critically ill patients. A simplex combined index—the RDW/albumin ratio—has been proposed for the prediction of mortality, as has the lactate/albumin ratio. The aim of this study was to evaluate the clinical utility of the RDW/albumin ratio regarding 28-day mortality in critically ill patients with pneumonia. Clinical data of critically ill patients with pneumonia who were hospitalized in the medical intensive care unit from May 2018 to December 2020, and received invasive mechanical ventilation (IMV), were reviewed retrospectively. The values of RDW, lactate, and albumin measured at the time of IMV, were used for the index calculations. Of the 234 patients, the median age was 76 years, and 74.2% were male. The 28-day mortality rate was 47.3%. The median RDW/albumin ratio was significantly higher in non-survivors than survivors at 28 days (5.8 vs. 4.9, p < 0.001). A higher RDW/albumin ratio was significantly associated with increased 28-day mortality (odds ratio [OR] 1.338, 95% confidence interval [CI] 1.094–1.637, p = 0.005). The area under the receiver operating curve (AUROC) was 0.694 (95% CI: 0.630–758, p < 0.005) to discern 28-day mortality without significant difference, compared with that of the lactate/albumin ratio. Our data suggest that high RDW/albumin ratio has a similar predictability to the lactate/albumin ratio in critically ill patients with pneumonia receiving IMV.
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Kokulu K, Sert ET. The role of the lactate/albumin ratio in predicting survival outcomes in patients resuscitated after out-of-hospital cardiac arrest: A preliminary report. Am J Emerg Med 2021; 50:670-674. [PMID: 34879484 DOI: 10.1016/j.ajem.2021.09.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To investigate the effect of lactate/albumin (L/A) ratio on survival to discharge in patients who have had out-of-hospital cardiac arrest (OHCA). METHODS We analyzed adult patients (aged ≥18 years) who were admitted to our hospital's emergency department (ED) due to OHCA between January 2018 and June 2020 and who achieved return of spontaneous circulation after successful resuscitation. Blood lactate and albumin concentrations were obtained within the first 10 min after admission to the ED. Patients were grouped according to clinical outcomes. The primary outcome was survival until hospital discharge. The groups were then statistically compared. RESULTS In this study, 235 OHCA patients were analyzed, 42 (17.9%) of whom had survived until discharge. The L/A ratio was higher in the non-survivor group than in the survivor group (2.0 (interquartile range: 1.4-2.8) vs 1.4 (0.9-1.9); P < 0.001). A low L/A ratio was significantly associated with survival at discharge (odds ratio: 2.55; 95% confidence interval (CI): 3.24-11.08; P < 0.001). In the prediction of survival to discharge, the area under the curve (AUC) for the L/A ratio (AUC: 0.823) was higher than that for lactate (AUC: 0.762) or albumin (AUC: 0.722) alone. Moreover, the predictive value of L/A ratio for survival to discharge might significantly improve when the cutoff value is higher than 1.62. CONCLUSION The L/A ratio is more valuable than the lactate or albumin levels alone in predicting survival to discharge. Our findings indicate that a combination of these parameters might increase the predictability of survival to discharge in OHCA patients.
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Affiliation(s)
- Kamil Kokulu
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey.
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University Medical School, Aksaray, Turkey
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Bou Chebl R, Geha M, Assaf M, Kattouf N, Haidar S, Abdeldaem K, Halawi N, Khamis M, Makki M, Tamim H, Abou Dagher G. The prognostic value of the lactate/albumin ratio for predicting mortality in septic patients presenting to the emergency department: a prospective study. Ann Med 2021; 53:2268-2277. [PMID: 34854770 PMCID: PMC8648034 DOI: 10.1080/07853890.2021.2009125] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/16/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Lactate/albumin (L/A) ratio is a biomarker in sepsis that has been shown to outperform lactate. This prospective study aims to validate the superior prognostic value of the L/A ratio to lactate in sepsis and septic shock. METHODS Prospective cohort conducted from September 2018 till February 2021 on adult patients presenting to the Emergency Department (ED) at a tertiary care centre with sepsis or septic shock. The primary outcome was the prognostic value of the L/A ratio compared to lactate with regards to mortality. RESULTS A total of 939 septic patients were included throughout the study period. A total of 236 patients developed septic shock. The AUC value of the L/A ratio in septic patients was 0.65 (95% CI 0.61-0.70) and was higher than that of lactate alone 0.60 (95% CI 0.55-0.64) with a p < .0001. The optimal L/A ratio cut-off threshold that separated survivors from non-survivors was found to be 0.115 for all septic patients. The AUC of the L/A ratio was significantly higher for patients with a lactate ≥2 mmol/L: 0.69 (95% CI 0.64-0.74) versus 0.60 (95% CI 0.54-0.66) with a p < .0001 as well as for patients with an albumin level less than 30 g/L (AUC = 0.69 95% CI= 0.62-0.75 vs AUC= 0.66 95% CI= 0.59-0.73, p = .04). Among septic shock patients there was no statically significant difference in the AUC value of the L/A ratio compared to lactate (0.53 95% CI 0.45-0.61 vs 0.50 95% CI 0.43-0.58 respectively with a p-value = .11). CONCLUSIONS The L/A ratio is a better predictor of in-patient mortality than lactate in sepsis patients. This superiority was not found in the septic shock subgroup. Our results encourage the use of the ratio early in the ED as a superior prognostic tool in sepsis patients.Key messagesWe aimed to assess the prognostic usefulness of the Lactate/Albumin ratio compared to lactate alone in septic and septic shock patients.The L/A ratio proved to be a better predictor of in-patient mortality than lactate alone in sepsis patients. This pattern also applies across various subgroups in our study (malignancy, diabetics, age above 65, lactate level less than 2 mmol/L, albumin less than 30 g/L). Our results favour the use of the L/A ratio over lactate alone in patients with sepsis and the previously mentioned subgroups.Our results do not favour the use of the ratio instead of lactate in septic shock patients as there was no statistically significant difference between the AUCs of the ratio and lactate alone.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mirabelle Geha
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Assaf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nadim Kattouf
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Saadeddine Haidar
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Karim Abdeldaem
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Nour Halawi
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamed Khamis
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Maha Makki
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
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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.
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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
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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.
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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
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Utility of the Lactate/Albumin Ratio as a Predictor for Mortality in Necrotizing Fasciitis Patients. Emerg Med Int 2021; 2021:3530298. [PMID: 34691782 PMCID: PMC8528631 DOI: 10.1155/2021/3530298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 10/07/2021] [Indexed: 12/14/2022] Open
Abstract
Background The lactate/albumin (L/A) ratio has been proposed as a prognostic marker because the ratio is associated with multiple organ failure and mortality in critically ill patients. We aimed to investigate the clinical utility of the L/A ratio as a good prognostic indicator of mortality in a cohort of necrotizing fasciitis patients. Method This retrospective study was conducted in two tertiary hospitals in Taiwan between 2015 and 2020. We reviewed adult patients with measured serum lactate and albumin on the emergency department (ED) arrival to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for outcome prediction. Result Of the 262 NF patients, 20 (7.63%) died in the hospital. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.76, 95% confidence interval [CI] 0.69–0.81, P < 0.01) was higher than lactate alone (0.71, 95% CI 0.65–0.74 P < 0.01) for predicting in-hospital mortality. The optimal cutoff of the L/A ratio was 1.61. The AUROC value of the L/A ratio was better than lactate alone regardless of normal lactate level. The cutoff of L/A ratio and hypoalbuminemia showed further discriminative value for in-hospital mortality even in patients with normal lactate levels. Conclusion The prognostic performance of the L/A ratio was superior to a single measurement of lactate for predicting in-hospital mortality and intensive care unit (ICU) lengths in necrotizing fasciitis patients. Aggressive intervention and intensive care were necessary for high-risk NF patients upon ED arrival.
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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: 14] [Impact Index Per Article: 4.7] [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.
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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
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Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis. PLoS One 2021; 16:e0255744. [PMID: 34407102 PMCID: PMC8372950 DOI: 10.1371/journal.pone.0255744] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/22/2021] [Indexed: 12/23/2022] Open
Abstract
Previous studies have shown that lactate/albumin ratio (LAR) can be used as a prognostic biomarker to independently predict the mortality of sepsis and severe heart failure. However, the role of LAR as an independent prognostic factor in all-cause mortality in patients with acute respiratory failure (ARF) remains to be clarified. Therefore, we retrospectively analyzed 2170 patients with ARF in Medical Information Mart for Intensive Care Database III from 2001 to 2012. By drawing the receiver operating characteristic curve, LAR shows a better predictive value in predicting the 30-day mortality of ARF patients (AUC: 0.646), which is higher than that of albumin (AUC: 0.631) or lactate (AUC: 0.616) alone, and even higher than SOFA score(AUC: 0.642). COX regression analysis and Kaplan-Meier curve objectively and intuitively show that high LAR is a risk factor for patients with ARF, which is positively correlated with all-cause mortality. As an easy-to-obtain and objective biomarker, LAR deserves further verification by multi-center prospective studies.
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The Prognostic Usefulness of the Lactate/Albumin Ratio for Predicting Clinical Outcomes in Out-of-Hospital Cardiac Arrest: a Prospective, Multicenter Observational Study (koCARC) Study. Shock 2021; 53:442-451. [PMID: 31306348 DOI: 10.1097/shk.0000000000001405] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to evaluate the lactate/albumin ratio (LAR) to identify its significance as a prognostic marker for favorable neurologic outcome and survival in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA). Based on the LAR and multiple parameters, we developed new nomograms and externally validated the tools. METHODS We conducted an observational study using a prospective, multicenter registry of out-of-cardiac arrest resuscitation provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017. RESULTS A total of 524 patients were included in this study. An increased LAR was significantly associated with decreased favorable neurologic outcomes (odds ratio [OR] 0.787; 95% confidence interval [CI], 0.630-0.983; P = 0.035) and survival at discharge (OR 0.744; 95% CI, 0.638-0.867; P < 0.001). The areas under the curve (AUCs) for predicting neurologic outcome and survival to discharge using the LAR were 0.824 (P < 0.001) and 0.781 (P < 0.001), respectively. An LAR value of more than the optimal cutoff values of 2.82 and 3.62 could significantly improve prediction of decreased favorable neurologic outcome and survival to discharge, respectively. We constructed nomograms based on the multivariate logistic model. The model for predicting favorable neurologic outcomes and survival discharge had AUCs of 0.927 (P < 0.001) and 0.872 (P < 0.001), respectively. CONCLUSION The prognostic performance of the LAR was superior to a single measurement of lactate for predicting favorable neurologic outcomes and survival to discharge after OHCA. The newly developed nomograms can provide rapid prediction of probability of clinical outcomes.
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Moustafa AA, Elhadidi AS, El-Nagar MA, Hassouna HM. Can Lactate Clearance Predict Mortality in Critically Ill Children? J Pediatr Intensive Care 2021; 12:112-117. [PMID: 37082472 PMCID: PMC10113011 DOI: 10.1055/s-0041-1730930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 04/08/2021] [Indexed: 10/21/2022] Open
Abstract
AbstractSerial evaluation of blood lactate, including lactate clearance, may have greater value over single measurement at the time of presentation. The rationale of the current study was to evaluate the use of lactate clearance after 6 hours of admission to pediatric intensive care unit (PICU) as a predictor of mortality in critically ill children. A prospective observational study was conducted in a nine-bed PICU of a tertiary care teaching hospital over a period of 6 months. Lactate levels were measured in arterial blood samples of 76 patients at the time of admission and 6 hours later. According to calculated lactate clearance, patients were divided into group A (lactate clearance more than 0) which included 71% of patients and group B (lactate clearance ≤0) which included 29% of patients. Lactate level at admission was a poor predictor of mortality (area under receiver operating characteristic curve [AUC] = 0.519, p = 0.789). Lactate clearance after 6 hours of admission was a significant predictor of mortality (AUC = 0.766, p < 0.001). Using Kaplan–Meier survival curve, overall survival was significantly better among group A (p < 0.001). Using multivariate logistic regression model, lactate clearance after 6 hours (odds ratio = 0.98, 95% confidence interval [CI]: 0.96–0.99) and The Pediatric Index of Mortality 2 (PIM2) score (odds ratio = 4.7, 95% CI: 1.85–12.28) had independent prognostic significance as regard to mortality (p = 0.030, 0.001 respectively). We conclude that lactate clearance after 6 hours of admission can predict mortality in critically ill children.
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Affiliation(s)
- Azza A. Moustafa
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abeer S. Elhadidi
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mona A. El-Nagar
- Department of Pediatrics, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Hadir M. Hassouna
- Department of Pediatrics and Pediatric Intensive Care, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:225-229. [PMID: 33745405 DOI: 10.1080/00365513.2021.1901306] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study aimed to compare the value of lactate, albumin, and lactate/albumin ratio for the prediction of mortality in sepsis patients. Patients admitted to the intensive care unit (ICU) due to sepsis between January 2016 and January 2019 were evaluated retrospectively. Lactate, albumin, and lactate/albumin ratio values were compared between surviving and non-surviving patients and their predictive value for mortality was evaluated. A total of 1136 sepsis patients admitted to the ICU were included in the study. The mortality rate was 42.7% (485/1136 patients). In ROC analysis for mortality prediction, the area under the curve and optimal cut-off values were 0.816 and >2.2 mmol/L for lactate, 0.812 and ≤26 g/L for albumin, and 0.869 and >0.71 for lactate/albumin ratio, respectively. Our analysis of lactate, albumin, and lactate/albumin ratio in the largest patient sample to date showed that lactate/albumin ratio was a stronger parameter than lactate or albumin alone in predicting mortality among sepsis patients in the ICU. Lactate/albumin ratio is an easily obtained parameter with potential value for critically ill patients.
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Affiliation(s)
- Esra Cakir
- Department of Anesthesiology and Clinical of Critical Care, Health Sciences University, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Isil Ozkocak Turan
- Department of Anesthesiology and Clinical of Critical Care, Health Sciences University, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Soffer S, Klang E, Barash Y, Grossman E, Zimlichman E. Predicting In-Hospital Mortality at Admission to the Medical Ward: A Big-Data Machine Learning Model. Am J Med 2021; 134:227-234.e4. [PMID: 32810465 DOI: 10.1016/j.amjmed.2020.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND General medical wards admit high-risk patients. Artificial intelligence algorithms can use big data for developing models to assess patients' risk stratification. The aim of this study was to develop a mortality prediction machine learning model using data available at the time of admission to the medical ward. METHODS We included consecutive patients (ages 18-100) admitted to medical wards at a single medical center (January 1, 2013-December 31, 2018). We constructed a machine learning model using patient characteristics, comorbidities, laboratory tests, and patients' emergency department (ED) management. The model was trained on data from the years 2013 to 2017 and validated on data from the year 2018. The area under the curve (AUC) for mortality prediction was used as an outcome metric. Youden index was used to find an optimal sensitivity-specificity cutoff point. RESULTS Of the 118,262 patients admitted to the medical ward, 6311 died (5.3%). The single variables with the highest AUCs were medications administered in the ED (AUC = 0.74), ED diagnosis (AUC = 0.74), and albumin (AUC = 0.73). The machine learning model yielded an AUC of 0.924 (95% confidence interval [CI]: 0.917-0.930). For Youden index, a sensitivity of 0.88 (95% CI: 0.86-0.89) and specificity of 0.83 (95% CI: 0.83-0.83) were observed. This corresponds to a false-positive rate of 1:5.9 and negative predictive value of 0.99. CONCLUSION A machine learning model outperforms single variables predictions of in-hospital mortality at the time of admission to the medical ward. Such a decision support tool has the potential to augment clinical decision-making regarding level of care needed for admitted patients.
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Affiliation(s)
- Shelly Soffer
- DeepVision Lab, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Eyal Klang
- DeepVision Lab, Tel-Hashomer, Israel; Department of Diagnostic Imaging, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yiftach Barash
- DeepVision Lab, Tel-Hashomer, Israel; Department of Diagnostic Imaging, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York
| | - Ehud Grossman
- Internal Medicine, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Zimlichman
- Hospital Management, Sheba Medical Center, Tel-Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Guo W, Zhao L, Zhao H, Zeng F, Peng C, Guo W, Yan H. The value of lactate/albumin ratio for predicting the clinical outcomes of critically ill patients with heart failure. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:118. [PMID: 33569420 PMCID: PMC7867948 DOI: 10.21037/atm-20-4519] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Previous studies have shown that the lactate/albumin (L/A) ratio plays a role in predicting the outcomes of septic shock or severe sepsis. However, the role of the L/A ratio in predicting the outcomes of critically ill patients with heart failure remains unclear. We therefore performed a retrospective study to clarify this issue. Methods The study was based on the Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC-III) database and included critically ill adult patients with heart failure. The primary endpoints were 28-day and 1-year all-cause mortality after admission at the intensive care unit. Results We analyzed 4,562 patients in this study. We divided the participants into five groups according to the L/A ratio: quintile (Q)1 (L/A ratio ≤0.40, n=913), Q2 (0.40< L/A ratio ≤0.51, n=912), Q3 (0.51< L/A ratio ≤0.66, n=912), Q4 (0.66< L/A ratio ≤0.92, n=912), and Q5 (L/A ratio >0.92, n=913). After stratifying by L/A ratio, the risk of 28-day and 1-year mortality were significantly different between the groups (log-rank P<0.001). Compared with the first quintile, the second, third, fourth, and fifth quintiles of the L/A ratio were associated with higher 28-day [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.21-2.03 for Q3, HR 1.72, 95% CI: 1.34-2.21 for Q4, and HR 3.15, 95% CI: 2.47-4.01 for Q5) and 1-year mortality (HR 1.19, 95% CI: 1.00-1.41 for Q2, HR 1.36, 95% CI: 1.15-1.60 for Q3, HR 1.42, 95% CI: 1.20-1.67 for Q4, and HR 2.46, 95% CI: 2.09-2.89 for Q5). The restricted cubic spline showed that the L/A ratio positively correlated with both 28-day and 1-year all-cause mortality. Conclusions The L/A ratio could serve as a predictor of short and long-term mortality in critically ill patients with heart failure.
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Affiliation(s)
- Wenqin Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Lingyue Zhao
- Department of Ambulatory Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Fanfang Zeng
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Changnong Peng
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Wenyu Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, Shenzhen, China
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Wiedermann CJ. Phases of fluid management and the roles of human albumin solution in perioperative and critically ill patients. Curr Med Res Opin 2020; 36:1961-1973. [PMID: 33090028 DOI: 10.1080/03007995.2020.1840970] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Positive fluid balance is common among critically ill patients and leads to worse outcomes, particularly in sepsis, acute respiratory distress syndrome, and acute kidney injury. Restrictive fluid infusion and active removal of accumulated fluid are being studied as approaches to prevent and treat fluid overload. Use of human albumin solutions has been investigated in different phases of restrictive fluid resuscitation, and this narrative literature review was undertaken to evaluate hypoalbuminemia and the roles of human serum albumin with respect to hypovolemia and its management. METHODS PubMed/EMBASE search terms were: "resuscitation," "fluids," "fluid therapy," "fluid balance," "plasma volume," "colloids," "crystalloids," "albumin," "hypoalbuminemia," "starch," "saline," "balanced salt solution," "gelatin," "goal-directed therapy" (English-language, pre-January 2020). Additional papers were identified by manual searching of reference lists. RESULTS Restrictive fluid administration, plus early vasopressor use, may reduce fluid balance, but in some cases fluid overload cannot be entirely avoided. Deresuscitation, with fluid actively removed through diuretics or ultrafiltration, reduces duration of mechanical ventilation and intensive care unit stay. Combining hyperoncotic human albumin solution with diuretics increases hemodynamic stability and diuresis. Hyperoncotic albumin corrects hypoalbuminemia and raises colloid osmotic pressure, limiting edema formation and potentially improving endothelial function. Serum levels of albumin relative to C-reactive protein and lactate may predict which patients will benefit most from albumin therapy. CONCLUSIONS Hyperoncotic human albumin solution facilitates restrictive fluid therapy and the effectiveness of deresuscitative measures. Current evidence is mostly from observational studies, and more randomized trials are needed to better establish a personalized approach to fluid management.
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Affiliation(s)
- Christian J Wiedermann
- Institute of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, Hall (Tyrol), Austria
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Bou Chebl R, Jamali S, Sabra M, Safa R, Berbari I, Shami A, Makki M, Tamim H, Abou Dagher G. Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department. Front Med (Lausanne) 2020; 7:550182. [PMID: 33072780 PMCID: PMC7536276 DOI: 10.3389/fmed.2020.550182] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
Background: The aim of this study is to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate only in predicting morbidity and mortality in sepsis patients. Methods: This was a single-center retrospective cohort study. All adult patients above the age of 18 with a diagnosis of sepsis who presented between January 1, 2014 and June 30, 2019 were included. The primary outcome was in-hospital mortality. Results: A total of 1,381 patients were included, 44% were female. Overall in-hospital mortality was 58.4% with the mortalities of sepsis and septic shock being 45.8 and 67%, respectively. 55.5% of patients were admitted to the intensive care unit. The area under the curve value for lactate was 0.61 (95% CI 0.57–0.65, p < 0.001) and for the L/A ratio was 0.67 (95% CI 0.63–0.70, p < 0.001). The cutoff generated was 1.22 (sensitivity 59%, specificity 62%) for the L/A ratio in all septic patients and 1.47 (sensitivity 60%, specificity 67%) in patients with septic shock. The L/A ratio was a predictor of in-hospital mortality (OR 1.53, CI 1.32–1.78, p < 0.001). Conclusion: The L/A ratio has better prognostic performance than initial serum lactate for in-hospital mortality in adult septic patients.
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Affiliation(s)
- Ralphe Bou Chebl
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah Jamali
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Mohamad Sabra
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rawan Safa
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Iskandar Berbari
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shami
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maha Makki
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- Clinical Research Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gilbert Abou Dagher
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Gharipour A, Razavi R, Gharipour M, Mukasa D. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am J Emerg Med 2020; 38:2088-2095. [PMID: 33152585 DOI: 10.1016/j.ajem.2020.06.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/14/2020] [Accepted: 06/22/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES We investigate the clinical utility of the lactate/albumin (L/A) ratio as an early prognostic marker of ICU mortality in a large cohort of unselected critically ill patients. METHODS A retrospective single-center study using data from the Multiparameter Intelligent Monitoring Intensive Care III (MIMIC-III) database collected between 2001 and 2012. We screened adult patients (age ≥ 15) with measured lactate and albumin on the first day of ICU stay to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for ICU mortality prediction. RESULTS The overall ICU mortality in the 6414 eligible ICU patients was 16.4%. L/A showed a receiver-operating characteristics area under the curve (ROC-AUC) value of 0.69 (95% CI: 0.67, 0.70) to predict ICU mortality, higher than lactate 0.67 (95%CI: 0.65, 0.69). Regardless of the lactate level, L/A yielded better ROC-AUC compared to the lactate level [normal lactate (<2.0 mmol/L): 0.63 vs 0.60; intermediate lactate (2.0 mmol/L ≤ lactate <4.0 mmol/L): 0.58 vs 0.56; high lactate (≥4.0 mmol/L): 0.67 vs 0.66]. L/A was a better prognostic marker for ICU mortality in patients with decreased lactate elimination [hepatic dysfunction: 0.72 vs 0.70; renal dysfunction 0.70 vs 0.68]. The L/A ratio ROC-AUC was better in patients with sepsis (0.68 vs 0.66) and those who developed severe sepsis or septic shock (0.68 vs 0.66). CONCLUSIONS The performance of L/A and lactate were equivalent in predicting ICU mortality and can be used as early prognostic markers for ICU patients with different initial lactate level and the presence of hepatic or renal dysfunction.
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Affiliation(s)
- Amin Gharipour
- Griffith University, Department Of Accounting, Finance and Economics, Gold coast Campus, Australia
| | - Rouzbeh Razavi
- Kent State University, Department of Management and Information Systems, Kent, OH, United States
| | - Mojgan Gharipour
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - David Mukasa
- Division of Genome and Health Big Data, Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
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Ge X, Liu H, Tang S, Wu Y, Pan Y, Liu W, Qi W, Ye L, Cao Q, Zhou W. Preoperative hypoalbuminemia is an independent risk factor for postoperative complications in Crohn's disease patients with normal BMI: A cohort study. Int J Surg 2020; 79:294-299. [PMID: 32505647 DOI: 10.1016/j.ijsu.2020.05.064] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Malnutrition is universal in Crohn's disease (CD). The body mass index (BMI) is used to assess nutritional status to predict postoperative complications in CD patients. However, some CD patients have a normal BMI. The aim of this study was to evaluate risk factors for postoperative complications in CD patients with normal preoperative BMI values. METHODS This retrospective observational study included 315 CD patients who underwent surgical treatment between December 2012 and January 2020. Patient data were collected from a prospectively maintained database. The risk factors for postoperative complications in CD patients with normal BMI values were identified by univariate and multivariate analyses. RESULTS In total, 315 eligible patients were included. The incidence of postoperative complications was 30.8%, consisting of 22.5% mild complications and 18.4% major complications. The albumin level, the C-reactive protein level, laparoscopic surgery, and operative time were significantly associated with postoperative outcomes. Multivariate analysis showed that a low preoperative albumin level (P = 0.013, OR = 2.991, 95% CI: 1.255-7.131) was an independent risk factor for postoperative complications in CD patients with normal BMI values. CONCLUSIONS A low preoperative albumin level was a risk factor for postoperative complications in CD patients with normal BMI values. Although some patients have a normal BMI, clinicians should still consider the preoperative albumin level in CD patients to evaluate their nutritional status and provide timely intervention to reduce the risk of postoperative complications.
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Affiliation(s)
- Xiaolong Ge
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huaying Liu
- Department of Medicine, GuangXi Medical College, Nanning, China
| | - Shasha Tang
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Pharmacy, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yipeng Pan
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Liu
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weilin Qi
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lingna Ye
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Zhou
- Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
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Machine learning for the detection of early immunological markers as predictors of multi-organ dysfunction. Sci Data 2019; 6:328. [PMID: 31857590 PMCID: PMC6923383 DOI: 10.1038/s41597-019-0337-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 12/05/2019] [Indexed: 12/14/2022] Open
Abstract
The immune response to major trauma has been analysed mainly within post-hospital admission settings where the inflammatory response is already underway and the early drivers of clinical outcome cannot be readily determined. Thus, there is a need to better understand the immediate immune response to injury and how this might influence important patient outcomes such as multi-organ dysfunction syndrome (MODS). In this study, we have assessed the immune response to trauma in 61 patients at three different post-injury time points (ultra-early (<=1 h), 4-12 h, 48-72 h) and analysed relationships with the development of MODS. We developed a pipeline using Absolute Shrinkage and Selection Operator and Elastic Net feature selection methods that were able to identify 3 physiological features (decrease in neutrophil CD62L and CD63 expression and monocyte CD63 expression and frequency) as possible biomarkers for MODS development. After univariate and multivariate analysis for each feature alongside a stability analysis, the addition of these 3 markers to standard clinical trauma injury severity scores yields a Generalized Liner Model (GLM) with an average Area Under the Curve value of 0.92 ± 0.06. This performance provides an 8% improvement over the Probability of Survival (PS14) outcome measure and a 13% improvement over the New Injury Severity Score (NISS) for identifying patients at risk of MODS.
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Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients. Shock 2019; 50:545-550. [PMID: 29461463 DOI: 10.1097/shk.0000000000001128] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
AIM The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients. METHODS This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival. RESULTS A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels. CONCLUSIONS The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.
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