Wang Biao, Chen Gang, Cao Yifei, Xue Jiping, Li Jia, Wu Yunfu
Department of Critical Care Medicine, The Affiliated Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu, PR China.
Department of Critical Care Medicine, The Affiliated Suzhou Municipal Hospital, Nanjing Medical University, Suzhou, Jiangsu, PR China.
J Crit Care. 2015 Apr;30(2):271-5. doi: 10.1016/j.jcrc.2014.10.030. Epub 2014 Nov 11.
This study examines the clinical utility of the increased lactate/albumin ratio as an indicator of multiple-organ dysfunction syndrome (MODS) and mortality in severe sepsis and septic shock.
We designed a prospective cohort study in an intensive care unit, and 54 patients with severe sepsis or septic shock were included. Data were used to determine a relationship between lactate/albumin ratio and the development of MODS and mortality. These associations were determined by the Mann-Whitney test, multiple logistic regression, plotting the receiver operating characteristic curve and Spearman test.
Lactate/albumin ratio level was higher in MODS patients on day 1 (median [interquartile range, or IQR], 2.295 [1.818-3.065]; n = 30, P < .0001) than in those without (median [IQR], 1.550 (1.428-1.685); n = 24), and on day 2, (median [IQR], 1.810 [1.377-2.448]; n = 26, P = .0022) it was higher than in those without (median [IQR], 1.172 (1.129-1.382); n = 23) on day 2. We found that lactate/albumin ratio was an independent predictor of the development of MODS (odds ratio, 5.5; P = .033; 95% confidence interval, 1.1-26.1) during intensive care unit stay. The area under the receiver operating characteristic curve showed that lactate/albumin ratio could predict MODS (0.8458) and mortality (0.8449). Furthermore, the higher the Acute Physiology and Chronic Health Evaluation II score, the more lactate/albumin ratio was discovered on day 1 (r = 0.5315, P < .0001) and day 2 (r = 0.5408, P < .0001), whereas the lower partial pressure of oxygen in arterial blood/fraction of inspired oxygen ratio, the more lactate/albumin ratio was illustrated on day 1 (r = -0.5143, P < .0001) and day 2 (r = -0.5420, P < .0001).
Increased lactate/albumin ratio correlates with the development of MODS and mortality in patients with severe sepsis and septic shock.
本研究探讨升高的乳酸/白蛋白比值作为严重脓毒症和脓毒性休克中多器官功能障碍综合征（MODS）及死亡率指标的临床效用。
我们在重症监护病房设计了一项前瞻性队列研究，纳入了54例严重脓毒症或脓毒性休克患者。数据用于确定乳酸/白蛋白比值与MODS发生及死亡率之间的关系。这些关联通过曼-惠特尼检验、多元逻辑回归、绘制受试者工作特征曲线及斯皮尔曼检验来确定。
MODS患者在第1天的乳酸/白蛋白比值水平较高（中位数[四分位间距，或IQR]，2.295[1.818 - 3.065]；n = 30，P <.0001），高于未发生MODS的患者（中位数[IQR]，1.550[1.428 - 1.685]；n = 24），在第2天（中位数[IQR]，1.810[1.377 - 2.448]；n = 26，P =.0022）也高于未发生MODS的患者（中位数[IQR]，1.172[1.129 - 1.382]；n = 23）。我们发现乳酸/白蛋白比值是重症监护病房住院期间MODS发生的独立预测因素（比值比，5.5；P =.033；95%置信区间，1.1 - 26.1）。受试者工作特征曲线下面积显示乳酸/白蛋白比值可预测MODS（0.8458）和死亡率（0.8449）。此外，急性生理与慢性健康状况评分II越高，第1天（r = 0.5315，P <.0001）和第2天（r = 0.5408，P <.0001）发现的乳酸/白蛋白比值越高，而动脉血氧分压/吸入氧分数比值越低，第1天（r = -0.5143，P <.0001）和第2天（r = -0.5420，P <.0001）显示的乳酸/白蛋白比值越高。
严重脓毒症和脓毒性休克患者中，升高的乳酸/白蛋白比值与MODS的发生及死亡率相关。
