Li Yongkai, Li Dandan, Yuan Xin, Nazila Haireti, Yang Liu, Xu Ran, Liu Xiaocong, Li Xin, Jiang Shuqing, Xialaibaitigu Saimaiti, Yang Jianzhong
Emergency Trauma Center, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830000, Xinjiang Uygur Autonomous Region, China. Corresponding author: Yang Jianzhong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Jan;35(1):61-65. doi: 10.3760/cma.j.cn121430-20220130-00108.
To investigate the prognostic value of early serum lactate, albumin, and lactate/albumin ratio (L/A) on the 28-day prognosis of adult patients with sepsis.
A retrospective cohort study was conducted among adult patients with sepsis admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December in 2020. Gender, age, comorbidities, lactate within 24 hours of admission, albumin, L/A, interleukin-6 (IL-6), procalcitonin (PCT), C-reactive protein (CRP) and 28-day prognosis were recorded. The receiver operator characteristic curve (ROC curve) was drawn to analyze the predictive value of lactate, albumin and L/A for 28-day mortality in patients with sepsis. Subgroup analysis of patients was performed according to the best cut-off value, Kaplan-Meier survival curves were drawn, and the 28-day cumulative survival of patients with sepsis was analyzed.
A total of 274 patients with sepsis were included, and 122 patients died at 28 days, with a 28-day mortality of 44.53%. Compared with the survival group, the age, the proportion of pulmonary infection, the proportion of shock, lactate, L/A and IL-6 in the death group were significantly increased, and albumin was significantly decreased [age (years): 65 (51, 79) vs. 57 (48, 73), pulmonary infection: 75.4% vs. 53.3%, shock: 37.7% vs. 15.1%, lactate (mmol/L): 4.76 (2.95, 9.23) vs. 2.21 (1.44, 3.19), L/A: 0.18 (0.10, 0.35) vs. 0.08 (0.05, 0.11), IL-6 (ng/L): 337.00 (97.73, 2 318.50) vs. 55.88 (25.26, 150.65), albumin (g/L): 27.68 (21.02, 33.03) vs. 29.62 (25.25, 34.23), all P < 0.05]. The area under the ROC curve (AUC) and 95% confidence interval (95%CI) of lactate, albumin, and L/A were 0.794 (95%CI was 0.741-0.840), 0.589 (95%CI was 0.528-0.647), 0.807 (95%CI was 0.755-0.852) for predicting 28-day mortality in sepsis patients. The optimal diagnostic cut-off value of lactate was 4.07 mmol/L, the sensitivity was 57.38%, the specificity was 92.76%. The optimal diagnostic cut-off value of albumin was 22.28 g/L, the sensitivity was 31.15%, the specificity was 92.76%. The optimal diagnostic cut-off of L/A was 0.16, the sensitivity was 54.92%, and the specificity was 95.39%. Subgroup analysis showed that the 28-day mortality of sepsis patients in the L/A > 0.16 group was significantly higher than that in the L/A ≤ 0.16 group [90.5% (67/74) vs. 27.5% (55/200), P < 0.001]. The 28-day mortality of sepsis patients in the albumin ≤ 22.28 g/L group was significantly higher than that in the albumin > 22.28 g/L group [77.6% (38/49) vs. 37.3% (84/225), P < 0.001]. The 28-day mortality in the group with lactate > 4.07 mmol/L was significantly higher than that in the group with lactate ≤ 4.07 mmol/L [86.4% (70/81) vs. 26.9% (52/193), P < 0.001]. The three were consistent with the analysis results of Kaplan-Meier survival curve.
The early serum lactate, albumin, and L/A were all valuable in predicting the 28-day prognosis of patients with sepsis, and L/A was better than lactate and albumin.
探讨早期血清乳酸、白蛋白及乳酸/白蛋白比值（L/A）对成年脓毒症患者28天预后的评估价值。
对2020年1月至12月在新疆医科大学第一附属医院住院的成年脓毒症患者进行回顾性队列研究。记录患者的性别、年龄、合并症、入院24小时内的乳酸、白蛋白、L/A、白细胞介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）及28天预后情况。绘制受试者工作特征曲线（ROC曲线），分析乳酸、白蛋白及L/A对脓毒症患者28天死亡率的预测价值。根据最佳截断值对患者进行亚组分析，绘制Kaplan-Meier生存曲线，分析脓毒症患者的28天累积生存率。
共纳入274例脓毒症患者，其中122例在28天时死亡，28天死亡率为44.53%。与存活组相比，死亡组患者的年龄、肺部感染比例、休克比例、乳酸、L/A及IL-6均显著升高，白蛋白显著降低[年龄（岁）：65（51，79）比57（48，73），肺部感染：75.4%比53.3%，休克：37.7%比15.1%，乳酸（mmol/L）：4.76（2.95，9.23）比2.21（1.44，3.19），L/A：0.18（0.10，0.35）比0.08（0.05，0.11），IL-6（ng/L）：337.00（97.73，2318.50）比55.88（25.26，150.65），白蛋白（g/L）：27.68（21.02，33.03）比29.62（25.25，34.23），均P<0.05]。乳酸、白蛋白及L/A预测脓毒症患者28天死亡率的ROC曲线下面积（AUC）及95%置信区间（95%CI）分别为0.794（95%CI为0.741 - 0.840）、0.589（95%CI为0.528 - 0.647）、0.807（95%CI为0.755 - 0.852）。乳酸的最佳诊断截断值为4.07 mmol/L，灵敏度为57.38%，特异度为92.76%。白蛋白的最佳诊断截断值为22.28 g/L，灵敏度为31.15%，特异度为92.76%。L/A的最佳诊断截断值为0.16，灵敏度为54.92%，特异度为95.39%。亚组分析显示，L/A>0.16组脓毒症患者的28天死亡率显著高于L/A≤0.16组[90.5%（67/74）比27.5%（55/200），P<0.001]。白蛋白≤22.28 g/L组脓毒症患者的28天死亡率显著高于白蛋白>22.28 g/L组[77.6%（38/49）比37.3%（84/225），P<0.001]。乳酸>4.07 mmol/L组的28天死亡率显著高于乳酸≤4.07 mmol/L组[86.4%（70/81）比26.9%（5
