Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients

Korean Shock Society (KoSS) Investigators

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

AIM: The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.

METHODS: This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival.

RESULTS: A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.

CONCLUSIONS: The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

Original languageEnglish
Pages (from-to)545-550
Number of pages6
JournalShock (Augusta, Ga.)
Volume50
Issue number5
DOIs
Publication statusPublished - 2018 Nov 1

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Albumins
Lactic Acid
Sepsis
Mortality
ROC Curve
Critical Illness
Hospital Emergency Service
Confidence Intervals
Kidney
Liver
Teaching Hospitals
Hypotension
Observational Studies
Registries
Shock

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients. / Korean Shock Society (KoSS) Investigators.

In: Shock (Augusta, Ga.), Vol. 50, No. 5, 01.11.2018, p. 545-550.

Research output: Contribution to journalArticle

Korean Shock Society (KoSS) Investigators. / Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients. In: Shock (Augusta, Ga.). 2018 ; Vol. 50, No. 5. pp. 545-550.
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title = "Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients",
abstract = "AIM: The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.METHODS: This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival.RESULTS: A total of 946 patients were included, with 22.5{\%} overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95{\%} confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95{\%} CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.CONCLUSIONS: The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.",
author = "{Korean Shock Society (KoSS) Investigators} and Jikyoung Shin and Hwang, {Sung Yeon} and Jo, {Ik Joon} and Kim, {Won Young} and Ryoo, {Seung Mok} and Kang, {Gu Hyun} and Kyuseok Kim and Jo, {You Hwan} and Chung, {Sung Phil} and Joo, {Young Seon} and Beom, {Jin Ho} and Young-Hoon Yoon and Han, {Kap Su} and Lim, {Tae Ho} and Choi, {Han Sung} and Kwon, {Woon Yong} and Suh, {Gil Joon} and Choi, {Sung Hyuk} and Shin, {Tae Gun}",
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T1 - Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients

AU - Korean Shock Society (KoSS) Investigators

AU - Shin, Jikyoung

AU - Hwang, Sung Yeon

AU - Jo, Ik Joon

AU - Kim, Won Young

AU - Ryoo, Seung Mok

AU - Kang, Gu Hyun

AU - Kim, Kyuseok

AU - Jo, You Hwan

AU - Chung, Sung Phil

AU - Joo, Young Seon

AU - Beom, Jin Ho

AU - Yoon, Young-Hoon

AU - Han, Kap Su

AU - Lim, Tae Ho

AU - Choi, Han Sung

AU - Kwon, Woon Yong

AU - Suh, Gil Joon

AU - Choi, Sung Hyuk

AU - Shin, Tae Gun

PY - 2018/11/1

Y1 - 2018/11/1

N2 - AIM: The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.METHODS: This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival.RESULTS: A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.CONCLUSIONS: The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

AB - AIM: The aim of this study was to evaluate the clinical utility of the lactate/albumin (L/A) ratio as a predictive factor of 28-day mortality in critically ill sepsis patients.METHODS: This is a retrospective observational study from a prospectively collected multicenter registry of 10 emergency departments (EDs) in teaching hospitals that participated in the Korean Shock Society. It enrolled patients who were 19 years of age or older who had a suspected or confirmed infection and evidence of refractory hypotension or hypoperfusion. The prognostic performance of the L/A ratio and lactate level for predicting 28-day mortality was assessed. Lactate and albumin levels were measured immediately after ED arrival.RESULTS: A total of 946 patients were included, with 22.5% overall 28-day mortality. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.69, 95% confidence interval [CI] 0.64-0.73, P < 0.01) was higher than that of lactate (0.65, 95% CI 0.61-0.70, P < 0.01) for predicting 28-day mortality. The optimal cutoff of the L/A ratio was 1.32. The AUROC value of the L/A ratio was better than that of lactate regardless of lactate level (normal [<2.0 mmol/L]: 0.68 vs. 0.55; intermediate [≥2.0, < 4.0 mmol/L]: 0.65 vs. 0.50; high [≥4.0 mmol/L]: 0.66 vs. 0.62). In the subgroup with decreased lactate elimination, the AUROC value of the L/A ratio was also significantly higher than that of lactate (hepatic dysfunction: 0.70 vs. 0.66; renal dysfunction: 0.71 vs. 0.67). The L/A ratio cut-off and hypoalbminemia showed further discriminative value for 28-day mortality even in patients with normal or intermediate lactate levels.CONCLUSIONS: The prognostic performance of the L/A ratio was superior to that of a single lactate measurement for predicting 28-day mortality of critically ill sepsis patients. L/A ratio can be a useful prognostic factor regardless of initial lactate level and the presence of hepatic or renal dysfunction.

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DO - 10.1097/SHK.0000000000001128

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