The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU
Abstract
:1. Introduction
2. Results
2.1. Study Population
2.2. Survival Data
2.3. Matched-Control Analysis
3. Discussion
4. Methods
4.1. Study Subjects
4.2. Statistical Analysis
4.3. Calculation of SAPS2 and APACHE score
5. Limitations
6. Conclusions
Acknowledgments
Author contributions
Conflicts of interest
References
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Clinical Characteristics | Survivors | Non-Survivors | Overall Cohort | p-Value | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Mean | SEM | Mean | SEM | Mean | SEM | |||||
age | 63.67 | 14.71 | 67.67 | 12.02 | 64.97 | 14.00 | 0.01 | |||
BMI (kg/m2) | 27.06 | 4.80 | 27.63 | 7.83 | 27.24 | 5.95 | 0.47 | |||
SAPS2 (pts) | 46.43 | 16.70 | 58.57 | 19.37 | 50.58 | 18.55 | <0.001 | |||
APACHE2 (pts) | 24.50 | 7.81 | 27.84 | 8.44 | 25.64 | 8.17 | 0.001 | |||
Median | Min. | Max. | Median | Min. | Max. | Median | Min. | Max. | p-Value | |
lactate (mmol/L) | 2.19 | 0.50 | 20.58 | 3.77 | 0.70 | 22.90 | 2.50 | 0.50 | 22.90 | <0.001 |
PCT (mmol/L) | 8.82 | 0.08 | 417.00 | 7.82 | 0.07 | 194.00 | 8.18 | 0.07 | 417.00 | 0.98 |
glucose (mmol/L) | 9.9 | 3.9 | 30.0 | 10.4 | 3.8 | 39.4 | 10.1 | 3.8 | 30.0 | 0.11 |
hemoglobin (mmol/L) | 6.60 | 2.50 | 10.30 | 6.60 | 4.80 | 8.90 | 6.60 | 2.5 | 10.30 | 0.35 |
ASAT (μmol/L·s) | 0.85 | 0.20 | 222.27 | 1.07 | 0.20 | 154.50 | 0.89 | 0.20 | 222.27 | 0.02 |
ALAT (μmol/L·s) | 0.58 | 0.08 | 41.81 | 0.73 | 0.10 | 71.70 | 0.63 | 0.08 | 71.70 | 0.03 |
γ-GT (μmol) | 1.24 | 0.10 | 15.22 | 1.44 | 0.14 | 14.68 | 1.31 | 0.10 | 15.22 | 0.14 |
bilirubin (μmol) | 17.0 | 1.8 | 405.0 | 19.0 | 3.0 | 551.0 | 18.0 | 1.8 | 551.0 | 0.28 |
leucocytes (G/L) | 14.2 | 0.1 | 195.1 | 14.9 | 0.2 | 70.9 | 14.5 | 0.1 | 195.1 | 0.83 |
BUN (mg/dL) | 12.8 | 1.9 | 59.6 | 19.5 | 0.5 | 80.2 | 14.4 | 0.5 | 80.2 | <0.001 |
creatinine (mg/dL) | 15.0 | 30.0 | 1609.0 | 212.5 | 23.0 | 952.0 | 175.0 | 23.0 | 1609.0 | <0.001 |
sodium (mmol/L) | 140 | 119 | 154 | 142 | 131 | 151 | 140 | 119 | 154 | 0.02 |
potassium (mmol/L) | 4.1 | 2.5 | 9.3 | 4.5 | 3.1 | 10.8 | 4.2 | 2.5 | 10.8 | <0.001 |
albumin (mg/L) | 20.00 | 10.00 | 57.00 | 18.00 | 10.00 | 27.00 | 19.00 | 10.00 | 57.00 | 0.01 |
lactate/albumin ratio | 0.09 | 0.02 | 0.15 | 0.31 | 0.15 | 2.00 | 0.14 | 0.02 | 2.00 | <0.001 |
Clinical Characteristics | Lactate/Albumin <0.15 | Lactate/Albumin >0.15 | p-Value | ||||
---|---|---|---|---|---|---|---|
Mean | SEM | Mean | SEM | ||||
age | 63.70 | 14.75 | 66.23 | 12.69 | 0.09 | ||
BMI (kg/m2) | 27.33 | 5.12 | 27.14 | 4.82 | 0.77 | ||
SAPS2 (pts) | 47.81 | 18.03 | 59.01 | 20.82 | <0.001 | ||
APACHE2 (pts) | 25.07 | 8.38 | 27.98 | 8.24 | <0.001 | ||
Laboratory Parameters | Median | Min. | Max. | Median | Min. | Max. | p-Value |
lactate (mmol/L) | 1.7 | 0.5 | 5.9 | 5.9 | 1.8 | 26.0 | <0.001 |
procalcitonin (mmol/L) | 6.5 | 0.1 | 161.9 | 10.1 | 0.2 | 188.6 | <0.001 |
glucose (mmol/L) | 9.9 | 5.3 | 25.3 | 9.7 | 3.9 | 30.0 | 0.95 |
hemoglobin (mmol/L) | 6.6 | 2.5 | 9.3 | 6.7 | 4.9 | 9.8 | 0.36 |
ASAT (μmol/L·s) | 0.75 | 0.20 | 106.95 | 1.44 | 0.20 | 154.50 | <0.001 |
ALAT (μmol/L·s) | 0.61 | 0.13 | 78.76 | 0.77 | 0.10 | 71.7 | <0.001 |
γ-GT (μmol) | 1.29 | 0.1 | 15.22 | 1.3 | 0.14 | 20.33 | 0.92 |
bilirubin (μmol) | 17.0 | 1.8 | 390.0 | 24.0 | 2.0 | 551.0 | <0.001 |
leucocytes (G/L) | 12.9 | 0.1 | 50.5 | 15.4 | 0.1 | 96.8 | 0.06 |
BUN (mg/dL) | 15.0 | 0.5 | 80.2 | 15.8 | 1.9 | 75.4 | 0.34 |
creatinine (mg/dL) | 174 | 30 | 870 | 192 | 52 | 1332 | 0.34 |
sodium (mmol/L) | 139 | 124 | 158 | 142 | 126 | 158 | 0.02 |
potassium (mmol/L) | 4.2 | 2.9 | 7.1 | 4.5 | 2.8 | 12.4 | 0.01 |
albumin (mg/L) | 21 | 10 | 60 | 17 | 10 | 30 | <0.001 |
Parameter | HR | 95%CI | p-Value | Non-Survivors Lactat/Albumin >0.15 | vs. | Non-Survivors Lactat/Albumin <0.15 |
---|---|---|---|---|---|---|
lactate/albumin >0.15 | 4.27 | 2.42–7.52 | <0.001 | 54% | vs. | 18% |
Multivariate Analysis | Univariate | Multivariate | ||||
---|---|---|---|---|---|---|
Model #1 | HR | 95%CI | p-Value | HR | 95%CI | p-Value |
lactate/albumin >0.15 | 2.5 | 1.85–3.37 | <0.001 | 1.65 | 1.20–2.29 | 0.002 |
APACHE2 | 1.05 | 1.03–1.07 | <0.001 | 1.05 | 1.03–1.07 | <0.001 |
Model #2 | ||||||
lactate/albumin >0.15 | 2.5 | 1.85-3.37 | <0.001 | 1.44 | 1.03–2.00 | 0.03 |
SAPS2 | 1.03 | 1.02–1.04 | <0.001 | 1.03 | 1.02–1.04 | <0.001 |
Model #3 | ||||||
lactate/albumin >0.15 | 2.5 | 1.85–3.37 | <0.001 | 2.94 | 2.39–3.60 | <0.001 |
glucose (mmol/L) | 1.01 | 0.99–1.03 | 0.41 | |||
leucocytes (G/L) | 1.003 | 0.993–1.013 | 0.55 | |||
heart rate (bpm) | 1.009 | 1.005–1.012 | <0.001 | |||
ASAT (μmol/L·s) | 1.004 | 0.995–1.013 | 0.41 | |||
ALAT (μmol/L·s) | 1.00 | 0.980–1.019 | 0.97 | |||
BUN (mg/dL) | 1.034 | 1.025–1.044 | <0.001 | |||
creatinine (mg/dL) | 0.999 | 0.998–0.999 | <0.001 |
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Lichtenauer, M.; Wernly, B.; Ohnewein, B.; Franz, M.; Kabisch, B.; Muessig, J.; Masyuk, M.; Lauten, A.; Schulze, P.C.; Hoppe, U.C.; 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. https://doi.org/10.3390/ijms18091893
Lichtenauer M, Wernly B, Ohnewein B, Franz M, Kabisch B, Muessig J, Masyuk M, Lauten A, Schulze PC, Hoppe UC, et al. The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. International Journal of Molecular Sciences. 2017; 18(9):1893. https://doi.org/10.3390/ijms18091893
Chicago/Turabian StyleLichtenauer, Michael, Bernhard Wernly, Bernhard Ohnewein, Marcus Franz, Bjoern Kabisch, Johanna Muessig, Maryna Masyuk, Alexander Lauten, Paul Christian Schulze, Uta C. Hoppe, and et al. 2017. "The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU" International Journal of Molecular Sciences 18, no. 9: 1893. https://doi.org/10.3390/ijms18091893