Duan Wentao, Yang Feng, Ling Hua, Li Qiong, Dai Xingui
Department of Critical Care Medicine, Affiliated Chenzhou Hospital (The First People's Hospital of Chenzhou), University of South China, Chenzhou, China.
Front Med (Lausanne). 2024 Aug 13;11:1422883. doi: 10.3389/fmed.2024.1422883. eCollection 2024.
The lactate to hematocrit ratio (LHR) has not been assessed for predicting all-cause death in sepsis patients. This study aims to evaluate the relationship between LHR and 30-day all-cause mortality in sepsis patients.
This retrospective study used the data from Medical information mart for intensive care IV (MIMIC-IV, version 2.0). Our study focused on adult sepsis patients who were initially hospitalized in the Intensive care unit (ICU). The prognostic significance of admission LHR for 30-day all-cause mortality was evaluated using a multivariate Cox regression model, ROC curve analysis, Kaplan-Meier curves, and subgroup analyses.
A total of 3,829 sepsis patients participated in this study. Among the cohort, 8.5% of individuals died within of 30 days ( < 0.001). The area under the curve (AUC) for LHR was 74.50% (95% CI: 71.6-77.50%), higher than arterial blood lactate (AUC = 71.30%), hematocrit (AUC = 64.80%), and shows no significant disadvantage compared to qSOFA, SOFA, and SAPS II. We further evaluated combining LHR with qSOFA score to predict mortality in sepsis patients, which shows more clinical significance. ROC curve analysis showed that 6.538 was the optimal cutoff value for survival and non-survival groups. With LHR ≥6.538 vs. LHR <6.538 ( < 0.001). Subgroup analysis showed significant interactions between LHR, age, sex, and simultaneous acute respiratory failure ( = 0.001-0.005).
LHR is an independent predictor of all-cause mortality in sepsis patients after admission, with superior predictive ability compared to blood lactate or hematocrit alone.
尚未评估乳酸与血细胞比容比值（LHR）对预测脓毒症患者全因死亡的作用。本研究旨在评估LHR与脓毒症患者30天全因死亡率之间的关系。
这项回顾性研究使用了重症监护医学信息数据库IV（MIMIC-IV，版本2.0）的数据。我们的研究聚焦于最初入住重症监护病房（ICU）的成年脓毒症患者。使用多变量Cox回归模型、ROC曲线分析、Kaplan-Meier曲线和亚组分析评估入院时LHR对30天全因死亡率的预后意义。
共有3829例脓毒症患者参与了本研究。在该队列中，8.5%的个体在30天内死亡（<0.001）。LHR的曲线下面积（AUC）为74.50%（95%CI：71.6 - 77.50%），高于动脉血乳酸（AUC = 71.30%）、血细胞比容（AUC = 64.80%），并且与qSOFA、SOFA和SAPS II相比无显著劣势。我们进一步评估了将LHR与qSOFA评分相结合以预测脓毒症患者死亡率，这显示出更大的临床意义。ROC曲线分析表明，6.538是生存组和非生存组的最佳截断值。LHR≥6.538与LHR<6.538相比（<0.001）。亚组分析显示LHR、年龄、性别和同时发生的急性呼吸衰竭之间存在显著交互作用（=0.001 - 0.005）。
LHR是脓毒症患者入院后全因死亡率的独立预测指标，与单独的血乳酸或血细胞比容相比具有更强的预测能力。
