The Lactate/Albumin Ratio is an Effective Predictor for Mortality in Critically Ill Children

Öz

Introduction: Many predictive biomarkers were developed to evaluate the prognosis and mortality of critically ill children. Serum lactate level is one common biomarker because hyperlactatemia is associated with mortality in these patients. Previous studies have shown that serum albumin level is also a useful biomarker. Several recent articles suggested that the combination of serum lactate and albumin is a more effective predictor of mortality in critically ill patients. This study aimed to determine whether the lactate/albumin (L/A) ratio was a better prognostic factor than serum lactate level alone.

Material and Methods: Thus, we retrospectively investigated the relationship between these biomarkers and their relationship with invasive mechanical ventilation, noninvasive mechanical ventilation support, inotropic drug need, acute renal kidney injury, continuous renal replacement therapy, mortality, and hospitalisation period.

Results: A total of 379 patients with a mean age of 4.8±5.3 years (range, 1 month to 18 years) were included in this study. The average duration of stay in the paediatric intensive care unit was 7.4±11.5 days, and the median L/A ratio was 0.46 (range, 0.11–10.0). Our findings indicate that the L/A ratio and serum lactate level were associated with mortality in critically ill children. However, our analysis also suggested that an L/A ratio of >0.5 upon admission is an overall better predictor of mortality.

Conclusion:We conclude that the L/A ratio is a useful and effective predictor of mortality in critically ill children.

Anahtar Kelimeler

• Paediatric intensive care unit
• prognosis
• lactate
• albumin

Laktat / Albümin Oranı, Kritik Hasta Çocuklarda Mortalite İçin Etkili Bir Belirleyicidir

Öz

Giriş: Kritik hasta çocukların prognozunu ve mortalitesini değerlendirmek için birçok öngörücü biyobelirteç geliştirilmiştir. Hiperlaktateminin kritik hastalarda mortalite ile ilişkili olması nedeniyle serum laktat seviyesi yaygın bir biyobelirteçtir. Önceki çalışmalar, serum albümin seviyesinin de faydalı bir biyobelirteç olduğunu göstermiştir. Bazı yeni makaleler, serum laktat ve albümin kombinasyonunun kritik hastalardaki ölüm oranlarını daha etkili bir belirleyicisi olduğunu ileri sürdü. Bu çalışmada laktat / albümin (L / A) oranının tek başına serum laktat seviyesinden daha iyi bir prognostik faktör olup olmadığını belirlemeyi amaçladık.

Gereç ve yöntemler: Bu nedenle bu biyobelirteçler ile invaziv mekanik ventilasyon, invaziv olmayan mekanik ventilasyon desteği, inotropik ilaç ihtiyacı, akut böbrek hasarı, sürekli renal replasman tedavisi, mortalite ve hastanede kalış süresi arasındaki ilişkiyi geriye dönük olarak inceledik.

Bulgular: Çalışmaya yaş ortalamaları 4.8 ± 5.3 yıl (1 ay ile 18 ay arasında değişen) 379 hasta dahil edildi. Pediatrik yoğun bakım ünitesinde ortalama kalış süresi 7.4 ± 11.5 gün, ortanca L / A oranı 0.46 (dağılım, 0.11-10.0) idi. Bulgularımız kritik hasta çocuklarda L / A oranı ve serum laktat seviyesinin mortalite ile ilişkili olduğunu göstermektedir. Bununla birlikte, analiz sonuçlarımız > 0.5 L / A oranının genel olarak daha iyi bir mortalite belirleyicisi olduğunu düşündürmektedir.

Sonuç:  L / A oranının kritik hasta çocuklarda mortalitenin yararlı ve etkili bir belirleyicisi olduğu sonucuna vardık.

Anahtar Kelimeler

• Pediatrik yoğun bakım ünitesi
• prognoz
• laktat
• albumin

Kaynakça

1. 1. Lanziotti VS, Póvoa P, Soares M, Silva JR, Barbosa AP, Salluh JI. Use of biomarkers in pediatric sepsis: literature review. Rev Bras Ter Intensiva 2016; 28: 472–482.2. Zhang Z, Xu X. Lactate clearance is a useful biomarker for the prediction of all–cause mortality in critically ill patients: a systematic review and meta–analysis. Crit Care Med 2014; 42: 2118–2125.3. Gibot S. On the origins of lactate during sepsis. Crit. Care 2012; 16: 151.4. Martin J, Blobner M, Busch R, Moser N, Kochs E, Luppa PB. Point–of–care testing on admission to the intensive care unit: lactate and glucose independently predict mortality. Clin Chem Lab Med 2013; 51: 405–412.5. Kim YA, Ha EJ, Jhang WK, Park SJ. Early blood lactate area as a prognostic marker in paediatric septic shock. Intensive Care Med 2013; 39: 1818–1823.6. Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, et. al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med 2016; 42: 202–210.7. Bai Z, Zhu X, Li M, et al. Effectiveness of predicting in–hospital mortality in critically ill children by assessing blood lactate levels at admission. BMC Pediatr 2014; 14: 83.8. Morris KP, McShane P, Stickley J, Parslow RC. The relationship between blood lactate concentration, the Paediatric Index of Mortality 2 (PIM2) and mortality in paediatric intensive care. Intensive Care Med. Intensive Care Med 2012; 38: 2042–2046.9. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern Emerg Med 2012; 7: S193–S199.10. Jellinge ME, Henriksen DP, Hallas P, Brabrand M. Hypoalbuminemia is a strong predictor of 30–day all–cause mortality in acutely admitted medical patients: a prospective, observational, cohort study. PloS One 2014; 9: e105983.11. 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: 271–275.12. Choi SJ, Ha EJ, Jhang WK, Park SJ. Association between the lactate/albumin ratio and mortality in pediatric septic shock patients with underlying chronic disease: Retrospective pilot study. Minerva Pediatr 2016.13. Shin J, Hwang SY, Jo IJ, et al. Prognostic value of the lactate/albumin ratio for predicting 28-day mortality in critically ill sepsis patients. Shock 2018; 50: 545–550. 14. Dellinger RP, Levv MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: Crit Care Med 2013; 41: 580–637.15. Rivers E, Nguyen B, Havstad S, et al. Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 2001; 345: 1368–137716. Jansen TC, Van BJ, Schoonderbeek FJ, et al. Early lactate–guided therapy in intensive care unit patients: a multicenter, open–label, randomized controlled trial. Am J Respir Crit Care Med 2010; 182: 752–76117. Taverna M, Marie, AL, Mira, JP, Guidet, B. Specific antioxidant properties of human serum albumin. Ann Intensive Care 2013; 3: 4.18. Gibbs J, Cull W, Henderson W, Daley J, Hur K, Khuri SF. Preoperative serum albumin level as a predictor of operative mortality and morbidity: results from the National VA Surgical Risk Study. Arch Surg 1999; 134: 36–42.19. Artero A1, Zaragoza R, Camarena JJ, Sancho S, González 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: 276–281.20. Scheiner B, Lindner G, Reiberger T, et al. Acid-base disorders in liver disease. J Hepatol 2017; 67: 1062–1073.21. Lichtenauer M, Wernly B, Ohnewein B, and et al. The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. Int J Mol Sci. 2017 Sep 2;18(9).22. Belletti A, Castro ML, Silvetti S and et al. Landoni G. The Effect of inotropes and vasopressors on mortality: a meta–analysis of randomized clinical trials. Br J Anaesth 2015;115: 656–675.