Abstract
Objective: To examine the clinical significance of the blood lactate (Lac)/serum albumin (Alb) ratio and the Lac/Alb × age score for assessing the severity and prognosis of patients with sepsis.Methods: A total of 8,029 patients with sepsis, aged >18 years were enrolled between June 2001 to October 2012 from the latest version of the Medical Information Mart for Intensive Care III (MIMIC-III v.1.4). The general data of the patients were obtained from hospital records and included gender, age, body mass index (BMI), laboratory indices, the sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS II). The patients were graded and scored according to their age and then divided into a survival or death group based on their prognosis. The Lac/Alb ratio after ICU admission was calculated and compared between the two groups. The risk factors for death in patients with sepsis were determined using multivariate logistic regression analysis, while mortality was examined using receiver operating characteristic (ROC) curve and survival curve plots. Finally, the values of the Lac/Alb ratio and Lac/Alb × age score for assessing prognosis of patients with sepsis were analyzed and compared.Results: After items with default values were excluded, a total of 4,555 patients with sepsis were enrolled (2,526 males and 2,029 females). 2,843 cases were classified as the death group and 1,712 cases in the survival group. (1) The mean age, BMI, SOFA and SAPS II scores were higher in the death group than those in the survival group. Significant differences in baseline data between the two groups were also observed. (2) The patients in the death group were divided further into four subgroups according to the quartile of the Lac/Alb ratio from low to high. Comparison of the four subgroups showed that the death rate rose with an increase in the Lac/Alb ratio, while analysis of the survival curve revealed that patients with a higher Lac/Alb ratio had a worse prognosis. (3) Multivariate logistic regression analysis showed that age ≥ 60 years, overweight (BMI ≥ 24 kg/m2), Lac/Alb ratio ≥ 0.16, SOFA score ≥ 2 points, and SAPS II ≥ 40 points were independent risk factors for death in patients with septic. (4) ROC curve analysis indicated that the SAPS II, Lac/Alb x age score, SOFA, and Lac/Alb ratio were the best predictors of death in patients with sepsis. The Lac/Alb × age score was characterized by its simple acquisition and ability to quickly analyze the prognosis of patients.Conclusion: (1)A high Lac/Alb ratio is an independent risk factor for death in patients with sepsis. (2) Although the prognosis of sepsis can be accurately and comprehensively assessed by multi-dimensional analysis of multiple indices, the Lac/Alb × age score is more accurate and convenient for providing a general assessment of prognosis, so is worthy of further clinical recognition.
Highlights
Sepsis is a clinical syndrome in which the host develops a systemic inflammatory response to infection [1] and life-threatening organ dysfunction [2] resulting in the condition being the major cause of death in critically ill patients
The results showed that the predictive value of the Lac/Alb ratio and sequential organ failure assessment (SOFA) score were similar and not significantly different (Lac/Alb: area under the ROC curve (AUC) = 0.61, P < 0.0001, 95%CI = 0.59–0.63, cut-off value = 0.16; SOFA: AUC = 0.64, P < 0.0001, 95%CI = 0.63–0.66; AUC Lac/Alb vs. AUC SOFA, P = 0.7384)
Our results demonstrated that the in-hospital mortality rate in sepsis patients was as high as 62.4% with baseline data of the mortality group showing an association between death and older age, higher body mass index (BMI), poorer organ function, and lower disease tolerance
Summary
Sepsis is a clinical syndrome in which the host develops a systemic inflammatory response to infection [1] and life-threatening organ dysfunction [2] resulting in the condition being the major cause of death in critically ill patients. The understanding of sepsis has increased continuously and medical technology has improved rapidly in recent years, the death rate of patients with sepsis remains high due to the combined effects of disorders in circulation and cellular metabolism. It is, necessary to pay close attention to assess the outcome of the disease. Lactate can be increased significantly by cellular ischemia and hypoxia and leads to metabolic disorders as a result of a further decline in the effective circulating volume of tissues. Blood Alb level is a nutritional index in patients, and an important marker for the incidence of complications and mortality of patients with sepsis
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