The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU.

Michael Lichtenauer,Marcus Franz,Alexander Lauten,Paul Schulze,Christian Jung,Bernhard Wernly,Bernhard Ohnewein,Johanna Muessig,Bjoern Kabisch,Uta Hoppe,Malte Kelm,Maryna Masyuk

doi:10.3390/ijms18091893

Abstract

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden’s index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long-term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill.

Highlights

Even to the present day, sepsis, including severe sepsis and septic shock, represents a major health care issue with concerning mortality rates [1,2,3,4,5]
We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill patients admitted to an intensive care unit (ICU)
We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio 0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01)

Summary

Introduction

Even to the present day, sepsis, including severe sepsis and septic shock, represents a major health care issue with concerning mortality rates [1,2,3,4,5]. The global trend even shows a rising incidence of sepsis and septic shock [7,8,9] despite generally decreasing mortality rates [10,11], which correlates with the establishment of the Early Goal Directed Therapy (EGDT) guideline [12,13] first published in 2001 [14]. Focusing on long-term prognosis, data have shown an up to 20% increased risk of death in patients suffering from sepsis as well as an increased risk of developing further sepsis in the future [18]

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