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)

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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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