Lactate / albumin ratio as prognostic tool for risk stratification in septic patients admitted to ICU

• Authors: Vasant Mourya , Rakesh Gupta , Amlendu Yadav , Rupesh Yadav

Abstracts

EN

INTRODUCTION: Sepsis stands as the primary cause behind intensive care unit (ICU) admissions. The most critical parameters in sepsis management have been shown to be early recognition. Management delays have been associated with increased mortality and morbidity The aim of this study is to study the lactate/albumin (L/A) ratio as prognostic tool for risk stratification in septic patients admitted to ICU. MATERIALS AND METHODS: This prospective observational study was conducted with100 patients. Admitted in ICU with sepsis and septic shock were studied. Serum lactate/albumin ratio was calculated at the time of admission. Apache 2 and SOFA score was calculated at admission. All patients received initial treatment according standard protocol. All patients were followed up till discharge. An adverse outcome in terms of in hospital mortality, length of ICU stays and inotropic support was used in this study. RESULTS: Lactate/albumin ratio >1.5(AUC 0.89) correctly predicted in-hospital mortality among 27% patients with sensitivity and specificity of 90% and 78.6% respectively (p value =0.001). Lactate/albumin ratio <1.50 (AUC 0.73) correctly predicted length of ICU stays <72 hours among 17% patients with sensitivity and specificity of 85% and 58.8% respectively (p value =0.001). Lactate/albumin ratio >1.50 (AUC 0.91) correctly predicted requiring inotropic support among 36% patients with sensitivity and specificity of 83.7% and 89.5% respectively (p value =0.001). CONCLUSIONS: We concluded that lactate/albumin ratio was a stronger parameter than lactate, albumin, APACHE score and SOFA alone in predicting mortality, length of ICU stay and requiring noradrenaline inotropic support among sepsis patients in the ICU.

Keywords

EN

Albumin; lactate; mortality; sepsis

• Publisher: Towarzystwo Pomocy Doraźnej
• Journal: Critical Care Innovations
• Year: 2023
• Volume: 6
• Issue: 4
• Pages: 11-22

Dates

published

2023

Contributors

author

Vasant Mourya

author

Rakesh Gupta

author

Amlendu Yadav

author

Rupesh Yadav

References

• De Backer D, Dorman T. Surviving sepsis guidelines: A continuous move toward better care of patients with sepsis. JAMA. 2017; 317(8): 807-808. doi: https://doi.org/10.1001/jama.2017.0059
• Yao YM, Luan Y. [Precision evaluation of immune status and its significance in sepsis after burns or trauma]. Zhonghua Shao Shang Za Zhi. 2018; 34(11): 786-789. doi: https://doi.org/10.3760/cma.j.issn.1009-2587.2018.11.013
• Yealy DM, Kellum JA, Huang DT, Barnato AE, Weissfeld LA, Pike F. A randomized trial of protocol-based care for early septic shock. N Engl J Med. 2014; 370: 1683-1693. doi: https://doi.org/10.1056/NEJMoa1401602
• Cabral L, Afreixo V, Meireles R, Vaz M, Chaves C, Caetano M, et al. Checking procalcitonin suitability for prognosis and antimicrobial therapy monitoring in burn patients. Burns Trauma 2018; 6: 10. doi: https://doi.org/10.1186/s41038-018-0112-5
• Kumar G, Kumar N, Taneja A, Kaleekal T, Tarima S, McGinley E, et al. Nationwide trends of severe sepsis in the 21st century (2000-2007). Chest 2011; 140(5): 1223-1231. doi: https://doi.org/10.1378/chest.11-0352
• Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al.. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016; 193(3): 259-272. doi: https://doi.org/10.1164/rccm.201504-0781OC
• Prescott HC, Osterholzer JJ, Langa KM, Angus DC, Iwashyna TJ. Late mortality after sepsis: propensity matched cohort study. BMJ 2016; 353 :i2375. doi: https://doi.org/10.1136/bmj.i2375
• Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Ann Intensive Care. 2013; 3(1): 12. doi: https://doi.org/10.1186/2110-5820-3-12
• Batul R, Gulzar U, Qayoom O. The Outcome of Sepsis Patients Admitted to the Surgical Intensive Care Unit. Arch Anesth & Crit Care. 2022; 9(2): 126-131. doi: https://doi.org/10.18502/aacc.v9i2.12510
• Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al.. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315(8): 801-810. doi: https://doi.org/10.1001/jama.2016.0287
• Villar J, Short JH, Lighthall G. Lactate Predicts Both Short- and Long-Term Mortality in Patients with and Without Sepsis. Infect Dis (Auckl). 2019; 12: 1178633719862776. doi: https://doi.org/10.1177/1178633719862776
• Assarian A, Noormandi A, Khalili H, Mohammadi M, Abdollahi A. Correlation between Serum Magnesium and Lactate Levels at the Time of ICU Admission and Early Phase of Sepsis. Arch Anesth & Crit Care. 2019; 5(3): 86-90. doi: https://doi.org/10.18502/aacc.v5i3.1207
• Wang B, Chen G, Cao Y, Xue J, Li J, Wu Y. Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J Crit Care. 2015; 30(2): 271-275. doi: https://doi.org/10.1016/j.jcrc.2014.10.030
• Lichtenauer M, Wernly B, Ohnewein B, Franz M, Kabisch B, Muessig J, et al.. The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. Int J Mol Sci. 2017; 18(9): 1893. doi: https://doi.org/10.3390/ijms18091893
• Hayashida K, Kondo Y, Hara Y, Aihara M, Yamakawa K. Head-to-head comparison of procalcitonin and presepsin for the diagnosis of sepsis in critically ill adult patients: a protocol for a systematic review and metaanalysis. BMJ Open 2017; 7(3): e014305. doi: https://doi.org/10.1136/bmjopen-2016-014305
• Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013; 35(2): 121-126. doi: https://doi.org/10.4103/0253-7176.116232
• Soong J, Soni N. Sepsis: recognition and treatment. Clin Med (Lond). 2012; 12(3): 276-280. doi: https://doi.org/10.7861/clinmedicine.12-3-276
• Aublanc M, Richard JC. Assessment of clinical criteria for sepsis-was the cart put before the horse? J Thorac Dis. 2016; 8(8): E816-E818. doi: https://doi.org/10.21037/jtd.2016.07.51
• 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. Scand J Clin Lab Invest. 2021; 81(3): 225-229. doi: https://doi.org/10.1080/00365513.2021.1901306
• 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(10): 2088-2095. doi: https://doi.org/10.1016/j.ajem.2020.06.067
• Li W, Wang M, Zhu B, Zhu Y, Xi X. Prediction of median survival time in sepsis patients by the SOFA score combined with different predictors. Burns Trauma 2020; 8: tkz006. doi: https://doi.org/10.1093/burnst/tkz006
• Bou Chebl R, Jamali S, Sabra M, Safa R, Berbari I, Shami A, et al.. Lactate/albumin ratio as a predictor of inhospital mortality in septic patients presenting to the emergency department. Front Med (Lausanne). 2020; 7: 550182. doi: https://doi.org/10.3389/fmed.2020.550182
• Noer A, Ganie RA, Solihat Y. The lactate/albumin ratio as a predictor of mortality sepsis patients in ICU. H. Adam Malik Hospital Medan and connected to Sofa scores. Glob J Res Anal. 2019; 8(8): 7- 9. doi: https://doi.org/10.36106/gjra

Identifiers

DOI

10.32114/CCI.2023.6.4.11.22

Biblioteka Nauki

29432047