Department of Anesthesiology and Intensive Care Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Anesthesiology, Buffalo University, Buffalo, NY, USA.
Sci Rep. 2022 Jul 29;12(1):13047. doi: 10.1038/s41598-022-14764-z.
The aim of this study was to evaluate the prognostic value of the Lactate to Albumin (L/A) ratio compared to that of lactate and lactate clearance in predicting outcomes in patients with septic shock. This was a multi-center observational study of adult patients with septic shock, who admitted to intensive care units (ICUs) at Shohada and Imam Reza Hospitals, Tabriz, Iran, between Sept 2018 and Jan 2021. The area under the curve (AUC) of receiver operating characteristic (ROC) curve and multivariate logistic regression analyses were used to explore associations of the L/A ratio, lactate and lactate clearance on the primary (mortality) and secondary outcomes [ICU length of stay (LOS), duration of mechanical ventilation (MV), need of renal replacement therapy (RRT) and duration of using vasopressors] at baseline, 6 h and 24 h of septic shock recognition. Best performing predictive value for mortality were related to lactate clearance at 24 h, L/A ratio at 6 h and lactate levels at 24 h with (AUC 0.963, 95% CI 0.918-0.987, P < 0.001), (AUC 0.917, 95% CI 0.861-0.956, P < 0.001), and (AUC 0.904, 95% CI 0.845-0.946, P < 0.001), respectively. Generally, the lactate clearance at 24 h had better prognostic performance for mortality and duration of using vasopressor. However, the L/A ratio had better prognostic performance than serum lactate and lactate clearance for RRT, ICU LOS and MV duration.
本研究旨在评估乳酸/白蛋白（L/A）比值与乳酸和乳酸清除率在预测脓毒性休克患者预后方面的价值。这是一项多中心观察性研究，纳入了 2018 年 9 月至 2021 年 1 月期间在伊朗大不里士舒哈达和伊玛目礼萨医院重症监护病房（ICU）收治的成年脓毒性休克患者。采用受试者工作特征（ROC）曲线下面积（AUC）和多变量逻辑回归分析来探讨 L/A 比值、乳酸和乳酸清除率与主要结局（死亡率）和次要结局[入住 ICU 时间（LOS）、机械通气（MV）时间、需要肾脏替代治疗（RRT）和使用升压药时间]之间的相关性。在脓毒性休克发生后 24 小时，乳酸清除率与死亡率的预测价值最佳，其次是 6 小时时的 L/A 比值和 24 小时时的乳酸水平（AUC 为 0.963，95%CI 为 0.918-0.987，P<0.001）、（AUC 为 0.917，95%CI 为 0.861-0.956，P<0.001）和（AUC 为 0.904，95%CI 为 0.845-0.946，P<0.001）。总的来说，24 小时时的乳酸清除率对死亡率和使用升压药时间具有更好的预后作用。然而，L/A 比值对 RRT、ICU LOS 和 MV 时间的预后作用优于血清乳酸和乳酸清除率。
