Cakir2021 Lactatealbumin Ratio Is More Effective Than Lactate or Albumin Alone in Predicting Clinical Outcomes in Intensive Care Patients With Sepsis
Cakir2021 Lactatealbumin Ratio Is More Effective Than Lactate or Albumin Alone in Predicting Clinical Outcomes in Intensive Care Patients With Sepsis
Cakir2021 Lactatealbumin Ratio Is More Effective Than Lactate or Albumin Alone in Predicting Clinical Outcomes in Intensive Care Patients With Sepsis
Investigation
To cite this article: Esra Cakir & Isil Ozkocak Turan (2021) 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, 81:3, 225-229, DOI:
10.1080/00365513.2021.1901306
Article views: 29
ORIGINAL ARTICLE
CONTACT Esra Cakir [email protected] Department of Anesthesiology and Clinical of Critical Care, Ankara Numune Education and Research
Hospital, Health Sciences University, Talatpasa Street, Ankara 06130, Turkey
ß 2021 Medisinsk Fysiologisk Forenings Forlag (MFFF)
226 E. CAKIR AND I. O. TURAN
Table 1. Comparison of demographic and clinical features between mortality and non-mortality.
Variables Non- mortality (n ¼ 651) Mortality (n ¼ 485) p Value
Age, (years),a 76 (29–98) 76 (39–101) .143
Male gender, n (%) 338 (51.9) 248 (51.1) .421
APACHE II score,a 18 (9–35) 24 (13–47) <.001
SOFA score,a 8 (3–17) 11 (5–21) <.001
Duration of MV, (days),a 4 (2–42) 9 (1–45) <.001
ICU stay, (days),a 19 (4–55) 21 (4–59) <.001
Bacteremia, n (%) 151 (23.2) 129 (26.6) .212
WBC, (x10E9/L),a 12.3 (1.2–31.0) 9.4 (1.8–44.6) .274
CRP, (mg/L),a 51 (11–362) 141 (19–446) <.001
Lactate, (mmol/L),a 1.4 (0.3–7.1) 2.7 (1.1–8.8) <.001
Albumin, (g/L)a 30 (18–49) 24 (10–45) <.001
Lactate/albumin ratio 0.44 (0.10–2.45) 1.27 (0.35–5.82) <.001
a
Median (minimum-maximum), APACHE II: acute physiology and chronic health evaluation score; CRP: C-reactive protein; ICU:
intensive care unit; MV: mechanical ventilation; SOFA: sepsis-related organ failure assessment score; WBC: white blood
cell count.
Statistically significant p values.
Figure 1. ROC curve for lactate, albumin, lactate/albumin ratio predicting mortality in patients with sepsis in intensive care unit.
cut-off values for lactate ranged from 2.3 to 2.5 mmol/L. be misinterpreted as an indicator of good prognosis in high-
These values are close to the optimal cut-off value in our risk patients [22].
analysis (> 2.2 mmol/L). However, previous studies reported Because impaired liver function disrupts albumin synthe-
lower AUC (0.660 and 0.700), sensitivity (60% and 55%), sis, serum albumin level is below normal in patients with
and specificity (67% and 61%) values compared to those hepatic dysfunction [4]. Moreover, albumin is a negative
obtained in our study (AUC ¼ 0.816, 78% sensitivity and acute phase protein that is rapidly down regulated in
77% specificity) [1,21]. Although these studies were similar response to inflammatory signals and can be a predictor of
to ours in terms of the patients’ ages, the difference in cut- negative clinical outcomes. Arnau-Barres et al. found that
off and AUC values may be due to the smaller patient sam- albumin was a determinant of mortality in sepsis patients.
ples in those studies, the presence of different underlying They reported that albumin level < 26 g/L was associated
diseases, and differences in sepsis severity. Nevertheless, ini- with 30-day mortality, similar to our results [17]. In a study
tial blood lactate level is commonly used in the ICU, as it including 348 patients, the AUC value of albumin for mor-
can provide clinicians information about the degree to tality in sepsis patients was 0.755, while this value was 0.812
which high-risk septic patients require ICU admission, in our study. This difference might be related to the patient
hemodynamic monitoring, and organ support [1]. Although sample of that study being smaller in number and younger
lactate is a well-studied prognostic biomarker, interpretation than ours (mean age 64 years vs. 76 years) [23]. Although
is complex due to the pathologic processes that can cause serum albumin level has prognostic value, it is affected by
elevated serum lactate levels. Normal lactate levels can also chronic illness, dietary supplementation, and inflammation,
228 E. CAKIR AND I. O. TURAN
and a single measurement may have limited prognostic patients’ values at admission. Follow-up values and the rela-
value [4]. So, albumin is likely less volatile than lactate, and tionship between these values and clinical outcomes could
is considered to be less valuable marker of frailty, especially not be evaluated. Finally, the patients’ nutritional status and
in the elderly. Thus, using additional indicators may provide liver and kidney functions, which can affect lactate and
more valuable information. albumin levels, could not be evaluated.
Due to these limitations related to the use of lactate and
albumin alone as prognostic factors, lactate/albumin ratio
Conclusion
enhances the prognostic value in sepsis [22]. As a result,
serum lactate and albumin were combined and lactate/albu- Based on the results of our study in the largest ICU case
min ratio has started to be used as a prognostic factor. In a series to date, lactate and albumin alone were found to be
study of 119 sepsis patients in a pediatric ICU, Moustafa strong predictors of mortality in patients admitted to the
et al. determined that the AUC of admitting lactate/albumin ICU due to sepsis. In addition, it was determined that lac-
ratio in the prediction of mortality was 0.681 and the cut- tate/albumin ratio can be used alone as an even stronger
off value was > 1.17. The AUC increased for 6 and 24 h val- predictor of mortality than both parameters separately.
ues (0.714 and 0.856, respectively), while cut-off values were Studies that include follow-up measurements and monitor-
similar (> 1.07 and > 1.1, respectively) [24]. Similar to our ing of additional parameters in a larger number of patients
results, Wang et al. reported that the AUC of lactate/albu- are needed to confirm our findings.
min ratio for predicting mortality was 0.844 and the cut-off
at 24 h was > 1.735 in adult ICU patients with sepsis [11].
Choi et al. determined a lactate/albumin ratio cut-off of > Disclosure statement
1.016 for the prediction of mortality [25]. In a study includ- No potential conflict of interest was reported by the author(s).
ing 1381 sepsis patients admitted to the emergency depart-
ment, the cut-off and AUC were reported as > 1.22 and
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