Admission blood lactate levels of patients diagnosed with cerebrovascular disease effects on short- and long-term mortality risk

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

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.

Association of lactate-to-albumin ratio with in-hospital and intensive care unit mortality in patients with intracerebral hemorrhage

Background

Intracerebral hemorrhage (ICH) is a severe stroke subtype with a high mortality rate; the lactate-to-albumin ratio (LAR) is a new biomarker for predicting clinical outcomes in patients with ICH. However, the relationship between LAR and mortality in patients with ICH treated in the intensive care unit (ICU) remains controversial. Therefore, in this study, we aimed to investigate the association between LAR and in-hospital and ICU mortality in patients with ICH.

Methods

Patients with ICH were selected from the Medical Information Mart for Intensive Care III (MIMIC-III) database; their clinical information, including baseline characteristics, vital signs, comorbidities, laboratory test results, and scoring systems, was extracted. Univariate and multivariate Cox proportional hazards analyses were used to investigate the association of LAR with in-hospital and ICU mortality. The maximum selection statistical method and subgroup analysis were used to investigate these relationships further. Kaplan-Meier (KM) analysis was used to draw survival curves.

Results

This study enrolled 237 patients with ICH whose lactate and albumin levels, with median values of 1.975 and 3.6 mg/dl, respectively, were measured within the first 24 h after ICU admission. LAR had an association with increased risk of in-hospital mortality [unadjusted hazards ratio (HR), 1.79; 95% confidence interval (CI), 1.32-2.42; p < 0.001] and ICU mortality (unadjusted HR, 1.88; 95% CI, 1.38-2.55; p < 0.001). A cut-off value of 0.963 mg/dl was used to classify patients into high LAR (≥0.963) and low LAR (<0.963) groups, and survival curves suggested that those two groups had significant survival differences (p = 0.0058 and 0.0048, respectively). Furthermore, the high LAR group with ICH had a significantly increased risk of in-hospital and ICU mortality compared to the low LAR group.

Conclusion

Our study suggests that a high LAR is associated with an increased risk of in-hospital and ICU mortality in patients with ICH. Thus, the LAR is a useful prognostic predictor of clinical outcomes in patients with ICH.

Investigation of an alternative education module in raising middle school student's awareness of acute stroke

INTRODUCTION

Public knowledge and recognition of stroke and prompt calls to ambulance services when stroke is suspected are vital to the survival of stroke patients and to minimize their disability. In this study, our aim was to investigate the effectiveness of an online education session to increase middle school (11-14-year-old) students' awareness of stroke.

METHODS

An interactive education session was organized for students using the online education portal of a local middle school. The effectiveness of this intervention was measured using knowledge measurement tests before, immediately after, and three months after the session. The compliance of the data with the normal distribution was checked with the Kolmogorov-Smirnov test. The McNemar chi-square analysis was used to compare the distribution of correct and incorrect answers among the tests, and one-way analysis of variance was conducted to compare the mean values of correct answers.

RESULTS

The students' stroke knowledge levels were found to be higher in both tests applied after the educational session and all the questions compared to the baseline evaluation. Stroke awareness was also determined to be higher among the students living with a family member aged over 65 years.

CONCLUSIONS

Online interactive education can increase students' awareness of stroke. Such programs can be included in the education curriculum of schools. Public awareness of vital diseases should continue even in extraordinary situations, such as pandemics.

The relationship between initial lactate levels and outcomes in patients diagnosed with diabetic ketoacidosis in the emergency department

Background/Aim: Diabetic ketoacidosis (DKA) is an endocrinological emergency frequently seen in emergency departments (ED). It can result in mortality if not treated appropriately. The aim of this study was to examine the relationship between baseline lactate levels and patient outcomes in DKA patients admitted to the emergency department (ED). Methods: This retrospective cohort study was carried out in the ED of a tertiary hospital between May 2022 and November 2022 using the data of patients diagnosed with DKA. Patients with missing data, patients transferred from another hospital, patients with a diagnosis other than DKA, and patients who could not be followed up were excluded from the study. The primary outcome of the study was admission to the intensive care unit (ICU) and/or in-hospital mortality. The area under the curve (AUC) was calculated by receiver operating characteristic (ROC) regression analyses to predict critically ill patients with lactate levels. Results: The study was completed with 95 patients. The mean age of the patients was 53.1 years and n = 46 were female. Twenty (21.1%) of these patients were admitted to the intensive care unit and 22 (23.2%) died. The statistical analysis showed that lactate levels were statistically significant in predicting critically ill patients (P < 0.001). ROC analysis showed that a lactate level of 2.6 mmol/dL could predict critically ill patients. The area under the curve was 0.823 (95% confidence interval: 0.731-0.894, sensitivity: 71.4, Specificity: 69.8), the Youden index was 0.476, and the P-value was 0.001. Conclusion: According to the results of this study, there is a significant relationship between the initial lactate levels in DKA patients and patients who will require critical care. Therefore, lactate can be used as an appropriate follow-up tool in the management of DKA patients.