ABSTRACT
Objective:To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.Methods:A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.Results:A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95% CI) of lactate, albumin, and L/A were 0.794 (95% CI was 0.741-0.840), 0.589 (95% CI was 0.528-0.647), 0.807 (95% CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve. Conclusion:The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.
ABSTRACT
Objective@#To analyze the predictive value of lactate/albumin(L/A) ratio in neonatal infants with septic shock.@*Methods@#The data of 185 neonatal infants with sepsis from January to December 2017 were retrospective analyzed in Guangdong Women and Children Hospital.The data were divided into low level of L/A group(L/A<0.1), medium level of L/A group(0.1≤L/A<0.2) and high level of L/A group(L/A≥0.2)according to L/A ratio level within 24 hours of sepsis.The clinical features, related laboratory indications and prognosis among the 3 groups were compared.Multivariate Logistic regression was used to analyze the effects of various factors on the occurrence of neonatal septic shock.Receiver operating characteristic (ROC) curve analysis was performed to evaluate the early predictive va-lue of related indicators for neonatal septic shock.@*Results@#A total of 185 neonatal infants with sepsis were collected.There were 88 cases in low level of L/A group, 64 cases in medium level of L/A group and 33 cases in high level of L/A group.There were no significant difference in gender, gestational age, birth weight, 1 and 5-minute Apgar scores, small for gestational age, use of pulmonary surfactant, maternal preeclampsia, gestational diabetes mellitus, maternal fever and severe meconium stained (all P>0.05). There were no statistical differences among three groups in C-reactive protein, white blood cell count, neutrophil count and proportion, leucine count and proportion and platelet count(all P>0.05). Compared with low and medium level of L/A groups, the high level of L/A group had higher proportion of cesarean section, higher procalcitonin and lactate, severe intracranial hemorrhage, periventricular leucomalacia, multiple organ dysfunction syndrome, disseminated intravascular coagulation, septic shock and the dead; low level of L/A group had higher proportion of maternal premature rupture of membranes>24 hours, albumin, pH or base excess(BE), and there were statistically significant differences in all of those(all P<0.05). Multivariate Logistic regression analysis showed that hypoalbuminemia, hyperlacticemia, decreased pH and L/A≥0.1 were independent predictors for neonatal septic shock.L/A more than 0.114 within 24 hours was associated with neonatal septic shock, with a sensitivity of 76.90% and specificity of 81.30%.@*Conclusions@#The increased of L/A within 24 hours of sepsis can be used as an independent risk factor for predicting septic shock in neonatal infants.
ABSTRACT
Objective To study the correlation between lactate/albumin ratio level and incidence of multiple organ dysfunction syndrome (MODS) as well as mortality in patients with severe sepsis or septic shock.Methods In January 2012-September 2013, 54 patients who were admitted to the intensive care unit(ICU) of a hospital developed severe sepsis and septic shock on the first day of admission, clinical data of patients were analyzed.Results On the first and second days of admission, 30(55.56%)and 26(53.06%)patients developed MODS;lactate/albumin ratio between MODS group and non-MODS group on the first and second days of admission were both significantly different (both P1.735 were 80.00%, 79.17%, 82.67%, and 75.92% respectively, sensitivity, specificity, positive predictive value, and negative predictive value of mortality were 100.00%, 51.02%, 17.23%, and 100.00% respectively.Conclusion Lactate/albumin ratio level is closely correlated with incidence and mortality of MODS in patients with severe sepsis or septic shock.