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Duan W, Yang F, Ling H, Li Q, Dai X. Association between lactate to hematocrit ratio and 30-day all-cause mortality in patients with sepsis: a retrospective analysis of the Medical Information Mart for Intensive Care IV database. Front Med (Lausanne) 2024; 11:1422883. [PMID: 39193015 PMCID: PMC11347292 DOI: 10.3389/fmed.2024.1422883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 08/02/2024] [Indexed: 08/29/2024] Open
Abstract
Background The lactate to hematocrit ratio (LHR) has not been assessed for predicting all-cause death in sepsis patients. This study aims to evaluate the relationship between LHR and 30-day all-cause mortality in sepsis patients. Methods This retrospective study used the data from Medical information mart for intensive care IV (MIMIC-IV, version 2.0). Our study focused on adult sepsis patients who were initially hospitalized in the Intensive care unit (ICU). The prognostic significance of admission LHR for 30-day all-cause mortality was evaluated using a multivariate Cox regression model, ROC curve analysis, Kaplan-Meier curves, and subgroup analyses. Results A total of 3,829 sepsis patients participated in this study. Among the cohort, 8.5% of individuals died within of 30 days (p < 0.001). The area under the curve (AUC) for LHR was 74.50% (95% CI: 71.6-77.50%), higher than arterial blood lactate (AUC = 71.30%), hematocrit (AUC = 64.80%), and shows no significant disadvantage compared to qSOFA, SOFA, and SAPS II. We further evaluated combining LHR with qSOFA score to predict mortality in sepsis patients, which shows more clinical significance. ROC curve analysis showed that 6.538 was the optimal cutoff value for survival and non-survival groups. With LHR ≥6.538 vs. LHR <6.538 (p < 0.001). Subgroup analysis showed significant interactions between LHR, age, sex, and simultaneous acute respiratory failure (p = 0.001-0.005). Conclusion LHR is an independent predictor of all-cause mortality in sepsis patients after admission, with superior predictive ability compared to blood lactate or hematocrit alone.
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Affiliation(s)
| | | | | | | | - Xingui Dai
- Department of Critical Care Medicine, Affiliated Chenzhou Hospital (The First People’s Hospital of Chenzhou), University of South China, Chenzhou, 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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Mahashabde ML, Bhimani YR, Bhavsar HM. The Correlation Between the Lactate/Albumin Ratio and Sequential Organ Failure Assessment (SOFA) Score in Patients With Sepsis and Septic Shock. Cureus 2024; 16:e65616. [PMID: 39205773 PMCID: PMC11357719 DOI: 10.7759/cureus.65616] [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: 07/09/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Background Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection, often resulting in severe outcomes such as septic shock and death. Globally, sepsis ranks among the most common causes of illness and death. The Sequential Organ Failure Assessment (SOFA) score is an established marker used to assess and predict the extent of organ failure in septic patients. The introduction of novel markers, such as the lactate/albumin (L/A) ratio, serves as a prognostic indicator in critical care settings, particularly for patients with sepsis. In this context, a higher L/A ratio upon admission aids in assessing disease severity and improving clinical decision-making to reduce mortality and adverse outcomes, which we aim to correlate through our study. Materials and methods This was an observational cross-sectional analysis conducted on 100 patients aged over 18 years who met the "Sepsis-3" guidelines and were admitted to the medical intensive care unit of Dr. D. Y. Patil Hospital, Pune, Maharashtra, India, between October 2022 and May 2024. Patients with chronic liver disease classified as Child-Pugh class C were excluded, as were those with chronic kidney disease (CKD). Written informed consent was obtained from each participant before the study. Data were collected through physical examination, routine laboratory investigations, and radiological assessments. Statistical analysis was performed using IBM SPSS version 20 (IBM Corp., Armonk, NY). Descriptive statistical analyses were conducted using the SPSS data editor. Statistical significance was considered at a p-value of less than 0.05 for all analyses. Results In the study population, 78 patients survived, while 22 patients died. The L/A ratio and SOFA score were significantly higher in non-survivors compared to survivors, both upon admission and thereafter, with statistical significance (p < 0.05). The correlation between the L/A ratio and the SOFA score was examined upon admission at 24 hours, 48 hours, day 7, and day 28. Pearson correlation analysis revealed statistically significant results (p < 0.05) throughout the entire study period. Conclusion A high L/A ratio, along with the SOFA score at ICU admission, was associated with a grave prognosis and poor outcomes, serving as independent risk factors for ICU admission. Therefore, patients with a high L/A ratio and SOFA score should be identified early and managed aggressively to avoid poor outcomes. Our study demonstrates that combining serum lactate and serum albumin levels into the L/A ratio significantly enhances prognostic accuracy compared to using serum lactate alone.
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Affiliation(s)
- Madhulika L Mahashabde
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Yash R Bhimani
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
| | - Harin M Bhavsar
- General Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, IND
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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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Zhao L, Wu L, Wang Z, Fan J, Li G. The lactate-to-albumin ratio relationship with all-cause mortality in cerebral infarction patients: analysis from the MIMIC-IV database. Front Neurol 2024; 15:1334097. [PMID: 38779217 PMCID: PMC11110838 DOI: 10.3389/fneur.2024.1334097] [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: 11/10/2023] [Accepted: 04/18/2024] [Indexed: 05/25/2024] Open
Abstract
Objective To examine the association of lactate-to-albumin ratio (LAR) with 30-day and 90-day mortality in patients with cerebral infarction admitted to the intensive care unit (ICU). Methods In this retrospective observational study, 1,089 patients with cerebral infarction were recruited. The concentration of blood lactate and serum albumin on the first day of ICU admission were recorded. The relationship between LAR levels and mortality was evaluated through univariate and multivariate Cox regression analyses, four-knot multivariate restricted cubic spline regression, and Kaplan-Meier (KM) curves. Results The overall 30-day and 90-day mortality rates in the entire cohort were 27.3 and 35.8%, respectively. KM analysis revealed a significant relationship between high LAR index and the risk of all-cause mortality (log-rank p < 0.001). Furthermore, multivariate Cox proportional risk analysis showed that the LAR index independently predicted the risk of 30-day mortality (HR: 1.38, 95% CI 1.15-1.64, p = 0.004) and 90-day mortality (HR: 1.53, 95% CI 1.32-1.77, p < 0.001) in the study population. Furthermore, a higher LAR exceeding 0.53 was positively correlated with the risk of 30-day and 90-day mortalities. Subsequent subgroup analyses demonstrated that LAR could predict the primary outcome. Conclusion In summary, the LAR index is a reliable and independent predictor of increased mortality among critically ill patients suffering from cerebral infarction. Nonetheless, there is a need for additional comprehensive prospective studies to validate these findings.
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Affiliation(s)
- Lingyan Zhao
- Wuxi Hospital of Traditional Chinese Medicine, Wuxi, China
| | - Linna Wu
- Medicine Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Zekun Wang
- Medicine Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Jing Fan
- Medicine Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guiping Li
- Medicine Acupuncture and Moxibustion Department, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
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Jiménez-Zarazúa O, Vélez-Ramírez L, Mondragón J. Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19. Heliyon 2024; 10:e28521. [PMID: 38576552 PMCID: PMC10990852 DOI: 10.1016/j.heliyon.2024.e28521] [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: 05/30/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024] Open
Abstract
Introduction Patients with septic shock face an elevated risk of mortality compared to those with sepsis. Several biomarkers, including lactate dehydrogenase, albumin, and lactate/albumin (L/A), have been associated with increased mortality in COVID-19 patients. This study aims to assess the relationship between sepsis, septic shock, and mortality, as well as the need for mechanical ventilation in COVID-19 patients. Demographic, sepsis severity factors, and biomarkers are examined. Methods A retrospective case series from June 2020 to March 2021 included 490 patients diagnosed with sepsis or septic shock secondary to SARS-CoV-2 pneumonia. Time-to-event analyses were conducted for mechanical ventilation and mortality. Statistical significance was set at p ≤ .0038. Serum lactate, albumin, lactate/albumin ratio, C-reactive protein, platelet levels, and three sepsis severity scales, (CCI, SOFA, APACHE IV) were assessed. Results Sepsis was identified in 352 patients (71.8%), while 138 had septic shock. Patients with septic shock were more likely to require invasive ventilator support. Factors associated with a higher risk of intubation included higher APACHE IV scores, elevated serum albumin levels, and increased L/A ratio. L/A ratio and serum lactate levels demonstrated the best diagnostic accuracy for mechanical ventilation (AUC, 0.964 and 0.946, respectively), mortality (AUC, 0.926 and 0.887, respectively). Discussion Increased C-reactive protein, combined with increased serum lactate and a high lactate/albumin ratio, may assist clinicians in identifying COVID-19 patients at risk of mechanical ventilation and mortality upon admission. Optimal cut-off values for lactate (1.45-1.65 mmol/L) and L/A ratio (0.413) can aid in prioritizing medical care for at risk COVID-19 patients.
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Affiliation(s)
- O. Jiménez-Zarazúa
- Hospital General Zona 21 IMSS, León, Department of Internal Medicine, Mexico
- Escuela Nacional de Estudios Superiores, Unidad León, Universidad Nacional Autonóma de México (UNAM), Leon, Guanajuato, Mexico
| | - L.N. Vélez-Ramírez
- Hospital General León, Department of Radiology, Mexico
- Department of Medicine and Nutrition, Universidad de Guanajuato, Leon, Guanajuato, Mexico
| | - J.D. Mondragón
- University of Groningen, University Medical Center Groningen, Department of Neurology, the Netherlands
- Universidad Nacional Autónoma de México, Instituto de Neurobiología, Departamento de Neurobiología Conductual y Cognitiva, Laboratorio de Psicofisiología, Querétaro, Mexico
- San Diego State University, Department of Psychology, Life-Span Human Senses Lab, San Diego, CA, USA
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Yoo KH, Choi SH, Suh GJ, Chung SP, Choi HS, Park YS, Jo YH, Shin TG, Lim TH, Kim WY, Lee J. The usefulness of lactate/albumin ratio, C-reactive protein/albumin ratio, procalcitonin/albumin ratio, SOFA, and qSOFA in predicting the prognosis of patients with sepsis who presented to EDs. Am J Emerg Med 2024; 78:1-7. [PMID: 38176175 DOI: 10.1016/j.ajem.2023.12.028] [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: 08/28/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/06/2024] Open
Abstract
PURPOSE Early identification of sepsis with a poor prognosis in the emergency department (ED) is crucial for prompt management and improved outcomes. This study aimed to examine the predictive value of sequential organ failure assessment (SOFA), quick SOFA (qSOFA), lactate to albumin ratio (LAR), C-reactive protein to albumin ratio (CAR), and procalcitonin to albumin ratio (PAR), obtained in the ED, as predictors for 28-day mortality in patients with sepsis and septic shock. MATERIALS AND METHODS We included 3499 patients (aged ≥19 years) from multicenter registry of the Korean Shock Society between October 2015 and December 2019. The SOFA score, qSOFA score, and lactate level at the time of registry enrollment were used. Albumin, C-reactive protein, and procalcitonin levels were obtained from the initial laboratory results measured upon ED arrival. We evaluated the predictive accuracy for 28-day mortality using the area under the receiver operating characteristic (AUROC) curve. A multivariable logistic regression analysis of the independent predictors of 28-day mortality was performed. The SOFA score, LAR, CAR, and PAR were converted to categorical variables using Youden's index and analyzed. Adjusting for confounding factors such as age, sex, comorbidities, and infection focus, adjusted odds ratios (aOR) were calculated. RESULTS Of the 3499 patients, 2707 (77.4%) were survivors, whereas 792 (22.6%) were non-survivors. The median age of the patients was 70 (25th-75th percentiles, 61-78), and 2042 (58.4%) were male. LAR for predicting 28-day mortality had the highest AUROC, followed by the SOFA score (0.715; 95% confidence interval (CI): 0.69-0.74 and 0.669; 95% CI: 0.65-0.69, respectively). The multivariable logistic regression analysis revealed that the aOR of LAR >1.52 was 3.75 (95% CI: 3.16-4.45), and the aOR, of SOFA score at enrollment >7.5 was 2.67 (95% CI: 2.25-3.17). CONCLUSION The results of this study showed that LAR is a relatively strong predictor of sepsis prognosis in the ED setting, indicating its potential as a straightforward and practical prognostic factor. This finding may assist healthcare providers in the ED by providing them with tools to risk-stratify patients and predict their mortality.
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Affiliation(s)
- Kyung Hun Yoo
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Han Sung Choi
- Department of Emergency Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea
| | - Yoo Seok Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Department of Emergency Medicine, Hanyang University Hospital, Seoul, Republic of Korea.
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Zhu B, Zhou R, Qin J, Li Y. Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis. Biomedicines 2024; 12:447. [PMID: 38398049 PMCID: PMC10886935 DOI: 10.3390/biomedicines12020447] [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: 01/15/2024] [Revised: 01/30/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
Background: Blood lactate is a potentially useful biomarker to predict the mortality and severity of sepsis. The purpose of this study is to systematically review the ability of lactate to predict hierarchical sepsis clinical outcomes and distinguish sepsis, severe sepsis and septic shock. Methods: We conducted an exhaustive search of the PubMed, Embase and Cochrane Library databases for studies published before 1 October 2022. Inclusion criteria mandated the presence of case-control, cohort studies and randomized controlled trials that established the association between before-treatment blood lactate levels and the mortality of individuals with sepsis, severe sepsis or septic shock. Data was analyzed using STATA Version 16.0. Results: A total of 127 studies, encompassing 107,445 patients, were ultimately incorporated into our analysis. Meta-analysis of blood lactate levels at varying thresholds revealed a statistically significant elevation in blood lactate levels predicting mortality (OR = 1.57, 95% CI 1.48-1.65, I2 = 92.8%, p < 0.00001). Blood lactate levels were significantly higher in non-survivors compared to survivors in sepsis patients (SMD = 0.77, 95% CI 0.74-0.79, I2 = 83.7%, p = 0.000). The prognostic utility of blood lactate in sepsis mortality was validated through hierarchical summary receiver operating characteristic curve (HSROC) analysis, yielding an area under the curve (AUC) of 0.72 (95% CI 0.68-0.76), accompanied by a summary sensitivity of 0.65 (95% CI 0.59-0.7) and a summary specificity of 0.7 (95% CI 0.64-0.75). Unfortunately, the network meta-analysis could not identify any significant differences in average blood lactate values' assessments among sepsis, severe sepsis and septic shock patients. Conclusions: This meta-analysis demonstrated that high-level blood lactate was associated with a higher risk of sepsis mortality. Lactate has a relatively accurate predictive ability for the mortality risk of sepsis. However, the network analysis found that the levels of blood lactate were not effective in distinguishing between patients with sepsis, severe sepsis and septic shock.
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Affiliation(s)
| | | | | | - Yifei Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20, 3rd Section, South Renmin Road, Chengdu 610041, China; (B.Z.); (R.Z.); (J.Q.)
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9
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Ma C, Liang G, Wang B, Eisenhut M, Urrechaga E, Wiedermann CJ, Andaluz-Ojeda D, O’Rourke J, Zhang Z, Jin X, Zhong X. Clinical value of the red blood cell distribution width to albumin ratio in the assessment of prognosis in critically ill patients with sepsis: a retrospective analysis. J Thorac Dis 2024; 16:516-529. [PMID: 38410549 PMCID: PMC10894361 DOI: 10.21037/jtd-23-1696] [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: 11/04/2023] [Accepted: 12/30/2023] [Indexed: 02/28/2024]
Abstract
Background Red blood cell (RBC) distribution width (RDW) to albumin ratio is a novel biomarker and its prognostic effect on critically ill patients with sepsis has not been extensively investigated. The objective of this study was to identify the prognostic value of the RDW to albumin ratio in these patients. Methods Data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III) database. A Cox proportional hazards model and restricted cubic spline model were used to determine the association of RDW to albumin ratio with mortality. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival curves were applied, and the area under the curve (AUC) was used to compare the predictive value. Results A total of 3,969 eligible patients were enrolled. The median RDW to albumin ratio was significantly higher in non-survivors than in survivors at 30 and 90 days. Patients were divided into groups according to the RDW to albumin ratio, and the risk of 30- and 90-day mortality markedly increased in the group with a higher ratio. The relationship between the RDW to albumin ratio as a continuous variable and 30-day mortality also showed an upward trend in the restricted cubic spline. The AUC of the RDW to albumin ratio was 0.633 in discriminating 30-day mortality which was similar to that of the lactate to albumin ratio (AUC =0.617; P=0.133) and higher than that of the neutrophil percentage to albumin ratio (AUC =0.559; P<0.001). Conclusions The RDW to albumin ratio is a promising biomarker for assessing the prognosis of critically ill patients with sepsis. Its predictive value in determining mortality was found to be similar to that of the lactate to albumin ratio and superior to that of the neutrophil percentage to albumin ratio.
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Affiliation(s)
- Chengyong Ma
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Guopeng Liang
- Department of Respiratory therapy, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Bo Wang
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Michael Eisenhut
- Paediatric Department, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Eloísa Urrechaga
- Hematology Laboratory, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Christian J. Wiedermann
- Department of Public Health, Medical Decision Making and HTA, University of Health Sciences, Medical Informatics and Technology, Hall, Austria
| | - David Andaluz-Ojeda
- Critical Care Area, Hospital Universitario HM Sanchinarro, HM Hospitales Madrid, Madrid, Spain
- Intensive Care Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - James O’Rourke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland
| | - Zhongwei Zhang
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Xiaodong Jin
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
| | - Xi Zhong
- Department of Critical Care Medicine, West China School of Medicine and West China Hospital, Sichuan University, Chengdu, China
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10
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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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Arı HF, Keskin A, Arı M, Aci R. Importance of lactate/albumin ratio in pediatric nosocomial infection and mortality at different times. Future Microbiol 2024; 19:51-59. [PMID: 37962487 DOI: 10.2217/fmb-2023-0125] [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: 05/27/2023] [Accepted: 09/05/2023] [Indexed: 11/15/2023] Open
Abstract
Aim: To evaluate the lactate/albumin ratio and its relation to mortality in children with nosocomial infections. Materials & methods: One hundred six children were included in this study. Blood gas and albumin levels were analyzed at the first, 24th and 48th h. Results: The types of detected microbial agents, signs of sepsis, development of septic shock and mortality rates were different. The first-, 24th- and 48th h lactate levels of the children who died were higher than those of the living children, but the albumin levels were lower. The highest area under the curve value for the lactate/albumin ratio was detected at the 24th h. Conclusion: Lactate/albumin ratio can be used to predict mortality in children with nosocomial infections.
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Affiliation(s)
- Hatice Feray Arı
- Aydın Gynecology & Pediatrics Hospital, Pediatric Intensive Care Department, Efeler, Aydın, 09020, Turkey
| | - Adem Keskin
- Department of Medicine Biochemistry, Institute of Health Sciences, Aydin Adnan Menderes University, Efeler, Aydın, 09100, Turkey
| | - Murat Arı
- Soke Vocational School of Health Services, Aydın Adnan Menderes University, Soke, Aydın, 09200, Turkey
| | - Recai Aci
- Department of Biochemistry, Samsun Training & Research Hospital, Ilkadim, Samsun, 55090, Turkey
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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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Zhong Y, Sun H, Chen H, Jing W, Chen W, Ma J. Association between lactate/albumin ratio and 28-day all-cause mortality in ischemic stroke patients without reperfusion therapy: a retrospective analysis of the MIMIC-IV database. Front Neurol 2023; 14:1271391. [PMID: 37900597 PMCID: PMC10601632 DOI: 10.3389/fneur.2023.1271391] [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: 08/02/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Objective The lactate/albumin ratio (LAR) has been used as a novel prognostic indicator for aneurysmal subarachnoid hemorrhage, traumatic brain injury, sepsis, heart failure, and acute respiratory failure. However, its potential in predicting all-cause mortality in patients with ischemic stroke (IS) has not been evaluated. Therefore, this study aimed to elucidate the correlation between LAR and 28-day all-cause mortality in IS patients without reperfusion therapy. Methods This retrospective cohort study used data from the Medical Information Mart for Intensive Care (MIMIC-IV) (v2.0) database. It included 568 IS adult patients admitted to the intensive care unit (ICU). The correlation between LAR and ICU 28-day all-cause mortality rate was analyzed using multiple COX regression analysis and Kaplan-Meier survival analysis. Restricted cubic spline (RCS) curves were used to assess the relationship between LAR and 28-day mortality. In addition, a subgroup analysis was performed to investigate the impact of other influencing factors on outcomes. The primary outcome was the ability of LAR to predict 28-day mortality in IS patients. Results Among the 568 patients with IS, 370 survived (survival group) and 198 died (non-survival group) within 28 days of admission (mortality rate: 34.9%). A multivariate COX regression analysis indicated that LAR was an independent predictor of all-cause mortality within 28 days after admission for patients with IS (hazard ratio: 1.32; 95% confidence interval: 1.03-1.68; P = 0.025). We constructed a model that included LAR, age, race, sex, white blood cell count, Sequential Organ Failure Assessment (SOFA) score, and anion gap (AG) and established a prediction model with an area under the curve (AUC) value of 71.5% (95% confidence interval: 67.1%-75.8%). The optimal cutoff value of LAR that separated the survival group and the non-survival group based on the Youden index was 0.55. The Kaplan-Meier survival curves plotted using this critical value showed that patients with LAR ≥ 0.55 had a significantly higher 28-day all-cause mortality rate than patients with LAR < 0.55 (P = 0.0083). Conclusion LAR can serve as an independent predictor of all-cause mortality within 28 days after admission for patients with IS.
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Affiliation(s)
- Yuan Zhong
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hao Sun
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Hongzhuang Chen
- Department of Critical Care Medicine, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Wenjuan Jing
- Department of Dermatology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Junqiang Ma
- Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, 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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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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Cai S, Wang Q, Chen C, Guo C, Zheng L, Yuan M. Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: A retrospective analysis of the fourth-generation Medical Information Mart for Intensive Care database. Front Nutr 2022; 9:967332. [PMID: 36407534 PMCID: PMC9672517 DOI: 10.3389/fnut.2022.967332] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND This study aimed to investigate the relationship between the blood urea nitrogen to serum albumin ratio (BAR) and in-hospital mortality in patients with sepsis. MATERIALS AND METHODS This is a retrospective cohort study. All septic patient data for the study were obtained from the intensive care unit of Beth Israel Deaconess Medical Center. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression analyses. Survival curves were plotted and subgroup analyses were stratified by relevant covariates. RESULTS Among 23,901 patients, 13,464 with sepsis were included. The overall in-hospital mortality rate was 18.9% (2550/13464). After adjustment for confounding factors, patients in the highest BAR quartile had an increased risk of sepsis death than those in the lowest BAR quartile (HR: 1.42, 95% CI: 1.3-1.55), using BAR as a categorical variable. When BAR was presented as a continuous variable, the prevalence of in-hospital sepsis-related death increased by 8% (adjusted HR: 1.08, 95% CI: 1.07-1.1, P < 0.001) for each 5-unit increase in BAR, irrespective of confounders. Stratified analyses indicated age interactions (P < 0.001), and the correlation between BAR and the probability of dying due to sepsis was stable. CONCLUSION BAR was significantly associated with in-hospital mortality in intensive care patients with sepsis. A higher BAR in patients with sepsis is associated with a worse prognosis in the ICU in the USA. However, further research is required to confirm this finding.
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Affiliation(s)
- Shaoyan Cai
- Department of Anesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Qinjia Wang
- Department of Gastroenterology, First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Chao Chen
- Department of Anesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Chunming Guo
- Department of Anesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Liangjie Zheng
- Department of Anesthesiology, Shantou Central Hospital, Shantou, Guangdong, China
| | - Min Yuan
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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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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C-Reactive Protein-to-Albumin Ratio as an Early Biomarker to Identify Sepsis in Neonates with Pneumonia. Mediators Inflamm 2022; 2022:4711018. [PMID: 35873709 PMCID: PMC9303482 DOI: 10.1155/2022/4711018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/08/2023] Open
Abstract
Objectives Neonates with pneumonia often also have sepsis, and the identifying sepsis from pneumonia may be a challenge for clinicians. However, there are no available data regarding the clinical value C-reactive protein-to-albumin ratio (CAR) in identifying sepsis in neonates with pneumonia. The aim of this study was to evaluate the clinical value of CAR in identifying sepsis in neonates with pneumonia. Methods 847 neonates with pneumonia were included in this study, of which 511 neonates were diagnosed with sepsis. Neonates were divided into the sepsis group and the nonsepsis group. All neonates underwent extensive and necessary clinical and laboratory tests. CAR was calculated as serum C-reactive protein (ng/ml)/albumin (mg/ml). All statistical analyses were performed using the statistical package SPSS 24.0, as appropriate. Results Compared with the nonsepsis group, neonates with sepsis have a higher CAR (P < 0.001). Further analysis showed that the prevalence of neonates with sepsis increased significantly from 41.0% in the low CAR group (CAR ≤ 0.024 × 10−3) to 80.0% in the high CAR group (CAR > 0.024 × 10−3) (P < 0.001). Correlation analysis showed that there was a strong positive correlation between CAR and PCT (r = 0.452, P < 0.001), nSOFA (r = 0.267, P < 0.001), and the prolonged length of hospital stay (r = 0.311, P < 0.001). Multiple logistic regression showed that CAR was an independent risk factor for the presence of sepsis in neonates with pneumonia. Receiver operating characteristic curve analysis revealed that CAR had adequate discriminatory power in predicting sepsis in neonates with pneumonia (area under curve (AUC) = 0.76, 95% CI 0.73-0.79, P < 0.001). Conclusions CAR can be used as a new marker to identify sepsis in neonates with pneumonia.
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