The Usefulness of Lactate/Albumin Ratio, C-Reactive Protein/Albumin Ratio, Procalcitonin/Albumin Ratio, SOFA, and qSOFA in Predicting the Prognosis of Patients with Sepsis Who Presented to Emergency Departments
Authors: Kyung Hun Yoo, Sung-Hyuk Choi, Gil Joon Suh, Sung Phil Chung, Han Sung Choi, Yoo Seok Park, You Hwan Jo, Tae Gun Shin, Tae Ho Lim, Won Young Kim, Juncheol Lee
Published in: American Journal of Emergency Medicine, 2023 December 20
Conclusion:
- Lactate to albumin ratio (LAR) is a strong predictor of 28-day mortality in sepsis patients in the ED, suggesting its utility as a practical prognostic factor.
- These findings can aid ED healthcare providers in risk stratifying patients and predicting mortality.
Purpose:
- To determine the predictive accuracy of various biomarkers and scoring systems (LAR, CAR, PAR, SOFA, qSOFA) for 28-day mortality in patients with sepsis and septic shock in the emergency department (ED).
Materials and Methods:
- Study included 3499 patients aged ≥19 years from the Korean Shock Society registry (October 2015 - December 2019).
- Evaluated SOFA score, qSOFA score, lactate level at enrollment, and initial laboratory results for albumin, C-reactive protein, and procalcitonin.
- Predictive accuracy for 28-day mortality assessed using area under the receiver operating characteristic (AUROC) curve.
- Multivariable logistic regression analysis performed to identify independent predictors of 28-day mortality.
- Adjusted odds ratios (aOR) calculated, considering factors like age, sex, comorbidities, and infection focus.
Results:
- Of the 3499 patients, 2707 (77.4%) survived, while 792 (22.6%) did not.
- Median age: 70 years; 58.4% male.
- Lactate to albumin ratio (LAR) had the highest AUROC for predicting 28-day mortality (0.715; 95% CI: 0.69-0.74), followed by the SOFA score (0.669; 95% CI: 0.65-0.69).
- Multivariable logistic regression showed:
- aOR for LAR >1.52: 3.75 (95% CI: 3.16-4.45).
- aOR for SOFA score >7.5 at enrollment: 2.67 (95% CI: 2.25-3.17).