Jss Medical College, Jssaher, Mysore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
The ability to predict the fate of critically ill patients admitted to an intensive care unit is very important, as there are only few studies which have focused on this aspect. Our study has focused to determine the relationship between C-Reactive protein/Albumin ratio (CAR) and Lactate/Albumin ratio (LAR) and Intensive care unit stay, the requirement for vasopressor and mechanical ventilator support, recovery and mortality in the patients admitted to critical care unit.
The study group comprised of 100 patients who were admitted to critical care unit. These patients were evaluated using a structured proforma, detailed case history and clinical examination. Blood sample collection was done after obtaining valid consent from the subjects immediately after admission and serum Albumin, Lactate and C- reactive protein levels were estimated in these patients.
The mean age of the patients in our study was 54.05.Out of the total patients admitted 74% of the patients were males. The common diagnosis was COVID bronchopneumonia (12%). 75% cases were seen having Glasgow Coma scale 15. 88% cases required FIO2 less than 50%. Based on Youden's index, LAR of 0.84 is the ideal cut off with 76.9% sensitivity and 83.8% specificity. Similarly for CAR, the ideal cut off is 88.2 with 84.6% sensitivity and 98.6% specificity. LAR and CAR values greater than 0.84 and 88.2 respectively were considered to be higher values. The patients with high LAR and high CAR values either had increased risk of mortality or increased duration of stay in the hospital (p=0.0001). Patients with low Albumin level and high CRP required Ventilator support which was statistically significant. Patients who needed inotropic support and mechanical ventilator support had higher CAR (P=0.001). Patients who received inotrope support had higher ESR and CRP levels.
CAR and LAR are better indicators of mortality and duration of stay in the intensive care unit as the patients with higher values of these ratios were found to have increased risk of mortality. However CAR was found to be a better indicator of mortality than LAR and it was also noted that the patients who required inotropes and mechanical ventilator support were found to have higher CAR.
预测入住重症监护病房的危重病患者的预后非常重要，因为只有少数研究关注这一方面。我们的研究重点是确定 C 反应蛋白/白蛋白比值 (CAR) 和乳酸/白蛋白比值 (LAR) 与入住重症监护病房的患者的 ICU 停留时间、血管加压药和机械通气支持的需求、恢复和死亡率之间的关系。
研究组包括 100 名入住重症监护病房的患者。这些患者使用结构化表格、详细的病历和临床检查进行评估。在获得受试者的有效同意后，立即采集血液样本，并在这些患者中估计血清白蛋白、乳酸和 C 反应蛋白水平。
我们研究中的患者平均年龄为 54.05 岁。在总共入院的患者中，74%为男性。常见的诊断是 COVID 支气管肺炎（12%）。75%的病例格拉斯哥昏迷量表评分为 15 分。88%的病例需要的 FIO2 小于 50%。根据 Youden 指数，LAR 为 0.84 是理想的截断值，灵敏度为 76.9%，特异性为 83.8%。同样对于 CAR，理想的截断值是 88.2，灵敏度为 84.6%，特异性为 98.6%。LAR 和 CAR 值分别大于 0.84 和 88.2 被认为是较高的值。LAR 和 CAR 值较高的患者死亡风险或住院时间延长的风险增加（p=0.0001）。低白蛋白水平和高 CRP 的患者需要呼吸机支持，这具有统计学意义。需要血管活性药物和机械通气支持的患者 CAR 较高（P=0.001）。接受血管活性药物支持的患者 ESR 和 CRP 水平较高。
CAR 和 LAR 是死亡率和 ICU 停留时间的更好指标，因为发现这些比值较高的患者死亡风险增加。然而，CAR 被发现是死亡率的更好指标，并且还注意到需要血管活性药物和机械通气支持的患者 CAR 较高。
