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Int. J. Mol. Sci. 2017, 18(9), 1893; doi:10.3390/ijms18091893

The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

1
Clinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria
2
Clinic of Internal Medicine I, Department of Cardiology, Jena University Hospital, 07747 Jena, Germany
3
Division of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, University Duesseldorf, Moorenstraße 5, 40225 Dusseldorf, Germany
4
Department of Cardiology, Charité—Universitaetsmedizin Berlin, 12203 Berlin, Germany
5
Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin, 13347 Berlin, Germany
*
Author to whom correspondence should be addressed.
Received: 28 July 2017 / Revised: 22 August 2017 / Accepted: 27 August 2017 / Published: 2 September 2017
(This article belongs to the Special Issue Sepsis)
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Abstract

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden’s index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long-term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill. View Full-Text
Keywords: critically ill patients; lactate; albumin; lactate/albumin ratio; ICU; risk stratification; risk score critically ill patients; lactate; albumin; lactate/albumin ratio; ICU; risk stratification; risk score
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MDPI and ACS Style

Lichtenauer, M.; Wernly, B.; Ohnewein, B.; Franz, M.; Kabisch, B.; Muessig, J.; Masyuk, M.; Lauten, A.; Schulze, P.C.; Hoppe, U.C.; Kelm, M.; Jung, C. The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. Int. J. Mol. Sci. 2017, 18, 1893.

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