Emergency and Trauma College, Hainan Medical University, Haikou, China.
Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China.
Postgrad Med. 2023 Apr;135(3):273-282. doi: 10.1080/00325481.2022.2110769. Epub 2022 Aug 9.
To investigate the predictive value of the arterial blood lactate to serum albumin ratio (LAR) on in-hospital mortality of patients with community-acquired pneumonia (CAP) admitted to the Intensive Care Unit (ICU).
Clinical datasets of 1720 CAP patients admitted to ICU from MIMIC-IV database were retrospectively analyzed. Patients were randomly assigned to the training cohort (n=1204) and the validation cohort (n=516) in a ratio of 7:3. X-tile software was used to find the optimal cut-off value for LAR. The receiver operating curve (ROC) analysis was conducted to compare the performance between LAR and other indicators. Univariate and multivariate Cox regression analyses were applied to select prognostic factors associated with in-hospital mortality. Based on the observed prognostic factors, a nomogram model was created in training cohort, and the validation cohort was utilized to further validate the nomogram.
The optimal cut-off value for LAR in CAP patients admitted to ICU was 1.6 (the units of lactate and albumin were, respectively, 'mmol/L' and 'g/dL'). The ROC analysis showed that the discrimination abilities of LAR were superior to other indicators except Sequential Organ Failure Assessment score and Simplified acute physiology score (SAPSII), which had the same abilities. Age, mean arterial pressure, SpO2, heart rate, SAPSII score, neutrophil-to-lymphocyte ratio, and LAR were found to be independent predictors of poor overall survival in the training cohort by multivariate Cox regression analysis and were incorporated into the nomogram for in-hospital mortality as independent factors. The nomogram model, exhibiting medium discrimination, had a C-index of 0.746 (95% CI = 0.715-0.777) in the training cohort and 0.716 (95% CI = 0.667-0.765) in the validation cohort.
LAR could predict in-hospital mortality of patients with CAP admitted to ICU independently as a readily accessible biomarker. The nomogram that included LAR with other independent factors performed well in predicting in-hospital mortality.
探讨动脉血乳酸与血清白蛋白比值（LAR）对重症监护病房（ICU）收治的社区获得性肺炎（CAP）患者住院死亡率的预测价值。
回顾性分析 MIMIC-IV 数据库中 1720 例 ICU 收治的 CAP 患者的临床数据集。患者按 7：3 的比例随机分配到训练队列（n=1204）和验证队列（n=516）。使用 X-tile 软件确定 LAR 的最佳截断值。进行受试者工作特征曲线（ROC）分析比较 LAR 与其他指标的性能。采用单因素和多因素 Cox 回归分析筛选与住院死亡率相关的预后因素。基于观察到的预后因素，在训练队列中创建列线图模型，并在验证队列中进一步验证该模型。
ICU 收治的 CAP 患者 LAR 的最佳截断值为 1.6（乳酸和白蛋白的单位分别为“mmol/L”和“g/dL”）。ROC 分析显示，LAR 的鉴别能力优于其他指标，除序贯器官衰竭评估评分和简化急性生理学评分（SAPSII）外，这两个指标的能力相同。多因素 Cox 回归分析发现，年龄、平均动脉压、SpO2、心率、SAPSII 评分、中性粒细胞与淋巴细胞比值和 LAR 是训练队列中总体生存率不良的独立预测因素，并将其作为独立因素纳入住院死亡率的列线图模型中。列线图模型具有中等的鉴别能力，在训练队列中的 C 指数为 0.746（95%可信区间：0.715-0.777），在验证队列中的 C 指数为 0.716（95%可信区间：0.667-0.765）。
LAR 可作为一种易于获得的生物标志物，独立预测 ICU 收治的 CAP 患者的住院死亡率。包含 LAR 和其他独立因素的列线图模型在预测住院死亡率方面表现良好。
