Acharya Chandra Prasad, Yadav Alok, Pokhrel Saugat, Bastola Sanjib, Jha Suprabha
Internal Medicine, Manipal College of Medical Sciences, Pokhara, Nepal.
Ann Med. 2025 Dec;57(1):2482024. doi: 10.1080/07853890.2025.2482024. Epub 2025 Mar 25.
Prognostic markers like SOFA and APACHE-II scores for sepsis and acute respiratory failure (ARF) are often complex for routine use. This study evaluated the lactate-albumin ratio (LAR) as a prognostic marker for in-hospital outcomes, mechanical ventilation, and inotrope requirement.
A prospective cohort study was conducted among ICU and Internal Medicine Unit patients at Manipal Teaching Hospital, approved by the Institutional Review Committee (approval number IRC/MCOMS/584). Arterial samples for ABG values (lactate, PaO2, PaCO2, HCO3, and FiO2) and venous samples for albumin, bilirubin and creatinine were collected on admission. Arterial lactate, serum albumin, LAR and SOFA scores were recorded and compared with in-hospital outcomes. Statistical analyses were performed using SPSS version 25, with ROC-AUC for assessing prognostic markers (LAR, lactate alone) and Delong's test for comparison.
Among 115 sepsis cases, ROC-AUC of LAR for in-hospital mortality (cut-off 1.78), mechanical ventilation (1.28), and inotropes (1.07) were 0.914, 0.881, and 0.819, respectively. Among 99 ARF cases, ROC-AUC for mortality (1.98), ventilation (1.10), and inotropes (1.18) were 0.878, 0.958, and 0.876. Among 43 sepsis + ARF cases, ROC-AUC for mortality (2.14), ventilation (1.20), and inotropes (1.20) were 0.853, 0.874, and 0.849.
The lactate-albumin ratio was a better prognostic marker than albumin alone and SOFA score for predicting in-hospital mortality, need for mechanical ventilation and inotropes in sepsis, ARF and combined Sepsis and ARF patients whereas it was statistically equivalent to lactate alone in predicting in hospital outcome. Lactate-albumin ratio also indicated disease progression, where an increase in cut-off value was seen with progressed or severe disease.
用于评估脓毒症和急性呼吸衰竭（ARF）的预后指标，如序贯器官衰竭评估（SOFA）和急性生理与慢性健康状况评分系统II（APACHE-II），在常规使用中通常较为复杂。本研究评估了乳酸-白蛋白比值（LAR）作为住院结局、机械通气和血管活性药物使用需求的预后指标。
在马尼帕尔教学医院的重症监护病房（ICU）和内科病房患者中进行了一项前瞻性队列研究，该研究经机构审查委员会批准（批准号IRC/MCOMS/584）。入院时采集动脉血样本检测动脉血气值（乳酸、动脉血氧分压、动脉血二氧化碳分压、碳酸氢根和吸入氧分数），采集静脉血样本检测白蛋白、胆红素和肌酐。记录动脉血乳酸、血清白蛋白、LAR和SOFA评分，并与住院结局进行比较。使用SPSS 25版进行统计分析，采用受试者工作特征曲线下面积（ROC-AUC）评估预后指标（LAR、单独的乳酸），并使用德龙检验进行比较。
在115例脓毒症病例中，LAR预测住院死亡率（临界值1.78）、机械通气（1.28）和血管活性药物使用（1.07）的ROC-AUC分别为0.914、0.881和0.819。在99例ARF病例中，LAR预测死亡率（1.98）、通气（1.10）和血管活性药物使用（1.18）的ROC-AUC分别为0.878、0.958和0.876。在43例脓毒症合并ARF病例中，LAR预测死亡率（2.14）、通气（1.20）和血管活性药物使用（1.20）的ROC-AUC分别为0.853、0.874和0.849。
对于预测脓毒症、ARF以及脓毒症合并ARF患者的住院死亡率、机械通气需求和血管活性药物使用需求，乳酸-白蛋白比值是比单独的白蛋白和SOFA评分更好的预后指标，而在预测住院结局方面，它与单独的乳酸在统计学上相当。乳酸-白蛋白比值还可指示疾病进展，随着疾病进展或病情严重，临界值会升高。
