Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon.
Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
Ann Med. 2021 Dec;53(1):2268-2277. doi: 10.1080/07853890.2021.2009125.
OBJECTIVES: Lactate/albumin (L/A) ratio is a biomarker in sepsis that has been shown to outperform lactate. This prospective study aims to validate the superior prognostic value of the L/A ratio to lactate in sepsis and septic shock. METHODS: Prospective cohort conducted from September 2018 till February 2021 on adult patients presenting to the Emergency Department (ED) at a tertiary care centre with sepsis or septic shock. The primary outcome was the prognostic value of the L/A ratio compared to lactate with regards to mortality. RESULTS: A total of 939 septic patients were included throughout the study period. A total of 236 patients developed septic shock. The AUC value of the L/A ratio in septic patients was 0.65 (95% CI 0.61-0.70) and was higher than that of lactate alone 0.60 (95% CI 0.55-0.64) with a < .0001. The optimal L/A ratio cut-off threshold that separated survivors from non-survivors was found to be 0.115 for all septic patients. The AUC of the L/A ratio was significantly higher for patients with a lactate ≥2 mmol/L: 0.69 (95% CI 0.64-0.74) versus 0.60 (95% CI 0.54-0.66) with a < .0001 as well as for patients with an albumin level less than 30 g/L (AUC = 0.69 95% CI= 0.62-0.75 vs AUC= 0.66 95% CI= 0.59-0.73, = .04). Among septic shock patients there was no statically significant difference in the AUC value of the L/A ratio compared to lactate (0.53 95% CI 0.45-0.61 vs 0.50 95% CI 0.43-0.58 respectively with a -value = .11). CONCLUSIONS: The L/A ratio is a better predictor of in-patient mortality than lactate in sepsis patients. This superiority was not found in the septic shock subgroup. Our results encourage the use of the ratio early in the ED as a superior prognostic tool in sepsis patients.Key messagesWe aimed to assess the prognostic usefulness of the Lactate/Albumin ratio compared to lactate alone in septic and septic shock patients.The L/A ratio proved to be a better predictor of in-patient mortality than lactate alone in sepsis patients. This pattern also applies across various subgroups in our study (malignancy, diabetics, age above 65, lactate level less than 2 mmol/L, albumin less than 30 g/L). Our results favour the use of the L/A ratio over lactate alone in patients with sepsis and the previously mentioned subgroups.Our results do not favour the use of the ratio instead of lactate in septic shock patients as there was no statistically significant difference between the AUCs of the ratio and lactate alone.
目的：乳酸/白蛋白（L/A）比值是脓毒症中的一种生物标志物，已被证明优于乳酸。本前瞻性研究旨在验证 L/A 比值较乳酸在脓毒症和脓毒性休克中的预后价值更优。
方法：这是一项于 2018 年 9 月至 2021 年 2 月在一家三级护理中心急诊科就诊的脓毒症或脓毒性休克成年患者中进行的前瞻性队列研究。主要结局是 L/A 比值与乳酸相比在死亡率方面的预后价值。
结果：整个研究期间共纳入了 939 例脓毒症患者。共有 236 例患者发生了脓毒性休克。脓毒症患者的 L/A 比值 AUC 值为 0.65（95%CI 0.61-0.70），高于单独乳酸的 AUC 值 0.60（95%CI 0.55-0.64），差异有统计学意义（P<0.0001）。发现 L/A 比值的最佳截断值为 0.115，可区分存活者和非存活者，适用于所有脓毒症患者。对于乳酸≥2mmol/L 的患者，L/A 比值的 AUC 值明显更高：0.69（95%CI 0.64-0.74）与 0.60（95%CI 0.54-0.66），差异有统计学意义（P<0.0001），对于白蛋白水平<30g/L 的患者（AUC=0.69，95%CI=0.62-0.75，与 AUC=0.66，95%CI=0.59-0.73，P=0.04）也是如此。在脓毒性休克患者中，L/A 比值与乳酸的 AUC 值之间无统计学差异（0.53，95%CI 0.45-0.61，与 0.50，95%CI 0.43-0.58，P=-0.11）。
结论：L/A 比值是预测脓毒症患者住院死亡率的更好指标，优于乳酸。在脓毒性休克亚组中未发现这种优势。我们的研究结果鼓励在急诊科早期使用该比值作为脓毒症患者的一种更好的预后工具。
关键信息：我们旨在评估乳酸/白蛋白比值与单独乳酸相比在脓毒症和脓毒性休克患者中的预后有用性。L/A 比值在脓毒症患者中被证明是比单独乳酸更好的住院死亡率预测指标。这种模式也适用于我们研究中的各种亚组（恶性肿瘤、糖尿病、年龄>65 岁、乳酸水平<2mmol/L、白蛋白<30g/L）。我们的研究结果支持在脓毒症患者和上述亚组中使用 L/A 比值代替单独乳酸。然而，我们的研究结果并不支持在脓毒性休克患者中使用比值代替乳酸，因为比值和单独乳酸的 AUC 值之间没有统计学差异。
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