Utility of the Lactate/Albumin Ratio as a Predictor for Mortality in Necrotizing Fasciitis Patients

Association of lactate/albumin ratio with in-hospital mortality in ICU patients with acute respiratory failure: A retrospective analysis based on MIMIC-IV database

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.

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

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.