Kokkoris Stelios, Gkoufa Aikaterini, Katsaros Dimitrios E, Karageorgiou Stavros, Kavallieratos Fotios, Tsilivarakis Dimitrios, Dimopoulou Georgia, Theodorou Evangelia, Mizi Eleftheria, Kotanidou Anastasia, Dimopoulou Ioanna, Routsi Christina
First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens Medical School, Evangelismos Hospital, 45-47 Ipsilantou Street, 10676 Athens, Greece.
J Clin Med. 2024 Nov 24;13(23):7106. doi: 10.3390/jcm13237106.
This study sought to evaluate the effectiveness of lactate/albumin ratio for ICU mortality prediction in a large cohort of patients with severe Coronavirus Disease-2019 (COVID-19) admitted to an intensive care unit (ICU). This is a single-center retrospective cohort study of prospectively collected data derived from the COVID-19 dataset for all critically ill patients admitted to an academic ICU. Data were used to determine the relation between lactate/albumin ratio and other laboratory parameters measured on the first day of the ICU stay and to evaluate the prognostic performance for ICU mortality prediction. A total of 805 ICU patients were included, and the median age (IQR) was 67 (57-76) years, with 68% being male. ICU mortality was 48%, and the median lactate/albumin ratio was 0.53 (0.39-0.59). A survival analysis showed that patients with higher lactate/albumin ratio values had significantly lower survival rates (Log Rank < 0.001). A multivariable analysis revealed that the lactate/albumin ratio was an independent risk factor for ICU mortality with a hazard ratio of 1.39 (CI: 1.27-1.52). The lactate/albumin ratio showed a receiver operating characteristics area under the curve (ROC-AUC) value to predict ICU mortality significantly higher than that of lactate alone (0.71 vs. 0.68, DeLong test < 0.001). The optimal lactate/albumin ratio cut-off for predicting ICU mortality was 0.57, with 63% sensitivity and 73% specificity. A subgroup analysis revealed that the lactate/albumin ratio was significantly associated with mortality across different patient groups, including age and sex categories, and those with or without hypertension and coronary heart disease. : Lactate/albumin ratio is a reliable prognostic marker in critically ill COVID-19 patients and could predict ICU mortality more accurately than lactate alone.
本研究旨在评估乳酸/白蛋白比值对入住重症监护病房（ICU）的大量重症2019冠状病毒病（COVID-19）患者的ICU死亡率预测效果。这是一项单中心回顾性队列研究，数据前瞻性收集自一所学术性ICU收治的所有危重症患者的COVID-19数据集。数据用于确定乳酸/白蛋白比值与入住ICU首日测得的其他实验室参数之间的关系，并评估ICU死亡率预测的预后性能。共纳入805例ICU患者，中位年龄（四分位间距）为67（57 - 76）岁，男性占68%。ICU死亡率为48%，乳酸/白蛋白比值中位数为0.53（0.39 - 0.59）。生存分析显示，乳酸/白蛋白比值较高的患者生存率显著较低（对数秩检验<0.001）。多变量分析显示，乳酸/白蛋白比值是ICU死亡率的独立危险因素，风险比为1.39（95%置信区间：1.27 - 1.52）。乳酸/白蛋白比值预测ICU死亡率的受试者工作特征曲线下面积（ROC-AUC）值显著高于单独乳酸（0.71对0.68，德龙检验<0.001）。预测ICU死亡率的最佳乳酸/白蛋白比值临界值为0.57，敏感性为63%，特异性为73%。亚组分析显示，乳酸/白蛋白比值与不同患者组的死亡率显著相关，包括年龄和性别类别，以及有无高血压和冠心病的患者。结论：乳酸/白蛋白比值是危重症COVID-19患者可靠的预后标志物，且比单独乳酸能更准确地预测ICU死亡率。
