Prognostic value of the lactate–albumin difference for predicting in-hospital mortality in critically ill patients with sepsis

Year 2022, Volume: 35 Issue: 1, 61 - 66, 31.01.2022

Gulbin Tore Altun Mustafa Kemal Arslantas Pelin Corman Dıncer Reyhan Arslantas Alper Kararmaz

https://doi.org/10.5472/marumj.1059093

Cited By: 2

Abstract

Objective: To evaluate the prognostic performance of the lactate–albumin difference (LAD), maximum lactate levels, and the Sequential Organ Failure Assessment (SOFA) score taken on the first day in critically ill patients with sepsis, on in-hospital mortality and 90-day survival.Patients and Methods: Data from the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4 were evaluated retrospectively. The first day data of adult patients with sepsis diagnosed according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria were recorded. The effectiveness of all diagnostic modalities on admission was analyzed to predict in-hospital mortality and 90-day survival.
Results: In-hospital mortality was 20.3% among the 2270 patients included in this study. The area below the receiver operating characteristic curve (AUC) value of the LAD was higher than lactate for predicting mortality (AUC, 0.691; 95% confidence interval [CI], 0.663–0.718; p< 0.01, and AUC, 0.675; 95% CI, 0.646–0.703; p< 0.01, respectively), and the AUC of SOFA score was the highest (AUC, 0.716; 95% CI, 0.663–0.718). The optimal cutoff of LAD was 0.7.
Conclusion: In addition to its easy and simple calculability relative to the SOFA, the prognostic performance of LAD was superior to maximum lactate levels for predicting in-hospital mortality and 90-day survival in adult patients with sepsis.

Keywords

Lactate-albumin difference, Lactate, Sepsis, In-hospital mortality, Survival

References

• Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016;315:801-10. doi: 10.1001/jama.2016.0287.
• Vasques F, Duscio E, Romitti F, et al. Septic shock-3 vs 2: an analysis of the ALBIOS
• study. Crit Care 2018;22:237. doi: 10.1001/jama.2016.0287.
• Baykara N, Akalin H, Arslantas MK, et al. Epidemiology of sepsis in intensive care units in Turkey: a multicenter, point-prevalence study. Crit Care 2018;22:93. doi: 10.1186/s13054-018-2013-1.
• Kraut JA, Madias NE. Lactic acidosis. N Engl J Med 2014;371:2309-19. doi: 10.1056/NEJMra1309483.
• Casserly B, Phillips GS, Schorr C, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med 2015;43:567-73. doi: 10.1097/CCM.0000000000000742.
• Hayashi Y, Endoh H, Kamimura N, Tamakawa T, Nitta M. Lactate indices as predictors of in-hospital mortality or 90-day survival after admission to an intensive care unit in unselected critically ill patients. PLoS One 2020;15:e0229135. doi: 10.1371/journal.pone.0229135.
• Liu Z, Meng Z, Li Y, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis. Scand J Trauma Resusc Emerg Med 2019;27:51. doi: 10.1186/s13049-019-0609-3
• Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707-10.
• Johnson AE, Pollard TJ, Shen L, et al. MIMIC-III, a freely accessible critical care database. Sci Data 2016;3:160035. doi: 10.1038/sdata.2016.35.
• Fluss R, Faraggi D, Reiser B. Estimation of the Youden Index and its associated cutoff point. Biom J 2005;47:458-72.
• Team R. RStudio: Integrated Development for R. RStudio: PBC, Boston, MA, 2020. Available from: http://www.rstudio.com/ Accessed on: 23.08.2021
• Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8-27.
• Hosmer DW, Lemeshow S. Applied Logistic Regression. Second ed. New York: Wiley, 2000.
• Villar J, Short JH, Lighthall G. Lactate predicts both short- and long-term mortality in patients with and without sepsis. Infect Dis (Auckl) 2019;12:1178633719862776. doi: 10.1177/1178633719862776.
• Ryoo SM, Lee J, Lee YS, et al. Lactate level versus lactate clearance for predicting mortality in patients with septic shock defined by Sepsis-3. Crit Care Med 2018;46:e489-e95. doi: 10.1097/CCM.0000000000003030.
• Gattinoni L, Vasques F, Camporota L, et al. Understanding lactatemia in human sepsis. potential impact for early management. Am J Respir Crit Care Med 2019;200:582-9. doi: 10.1164/rccm.201812-2342OC.
• Vincent JL, Quintairos ESA, Couto L, Jr., Taccone FS. The value of blood lactate kinetics in critically ill patients: a systematic review. Crit Care 2016;20:257. doi: 10.1186/s13054-016-1403-5.
• Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr 2019;43:181-93. doi: 10.1002/jpen.1451.
• Yin M, Si L, Qin W, Li C, Zhang J, Yang H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med 2018;33:687-94. doi: 10.1177/0885066616685300
• Artero A, Zaragoza R, Camarena JJ, Sancho S, Gonzalez R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care 2010;25:276-81. doi: 10.1016/j.jcrc.2009.12.004
• Wang B, Chen G, Cao Y, Xue J, Li J, Wu Y. Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J Crit Care 2015;30:271-5. doi: 10.1016/j.jcrc.2014.10.030
• Lichtenauer M, Wernly B, Ohnewein B, et al. The lactate/albumin ratio: a valuable tool for risk stratification in septic patients admitted to icu. Int J Mol Sci 2017;18:1893. doi: 10.3390/ijms18091893.
• Arslantas MK, Arslantas R, Dincer PC, Altun GT, Kararmaz A. Prognostic value of the lactate-albumin difference in predicting 30-day mortality in critically ill patients. Shock 2021;56:150-1. doi: 10.1097/SHK.0000000000001613.