Comparison of lactate/albumin ratio and established scoring systems for predicting mortality in critically ill cirrhotic patients.

Abstract

Critically ill cirrhotic patients may present a serious clinical condition defined as acute-on-chronic liver failure with high mortality. While established scoring systems like Child-Pugh and Model for End-stage Liver Disease (MELD) offer prognostic insights, their limitations warrant exploration of alternative markers. The lactate/albumin ratio (LAR) serves as a potential prognostic indicator in critical care settings, yet its utility in cirrhotic patients remains underexplored. We assessed 175 critically ill cirrhotic patients in this retrospective cohort study. Clinical severity scores, including Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and chronic liver failure-organ failure score (CLIF-OF), were compared with LAR along with traditional liver failure scoring systems. Logistic regression and receiver operating characteristic curve analysis were used to evaluate prognostic performance. Intensive care unit (ICU) nonsurvivors had significantly higher scores in all liver failure and clinical severity scores compared to survivors (p<0.001). Median LAR was significantly higher in nonsurvivors (p<0.001). ROC analysis revealed comparable prognostic accuracy between LAR, APACHE II, SOFA, and CLIF-OF scores in predicting ICU mortality. Logistic regression identified SOFA score at 48th hours, LAR, and requirement of mechanical ventilation as independent predictors of ICU mortality. LAR demonstrates promising prognostic utility in predicting ICU mortality among critically ill cirrhotic patients, complementing established scoring systems. Early reassessment using SOFA score at 48th hours may guide therapeutic interventions and improve patient outcomes. Further prospective studies are warranted to validate these findings and optimize clinical management strategies.