Document Type : Original Article
Authors
1
Lecturer of Internal Medicine, Faculty of Medicine - Zagazig University
2
Professor of Internal Medicine, Faculty of Medicine - Zagazig University
3
M.B.B.CH, Faculty of Medicine, Zagazig University
4
Colleague of Internal Medicine, Faculty of Medicine, Zagazig University
Abstract
Background: Sepsis as well as septic shock remain major causes of intensive care unit (ICU) mortality. lactate-to-albumin ratio (LAR), a simple biochemical index, has been proposed as a novel prognostic biomarker. We aimed in this research to evaluate prognostic performance of LAR for ICU mortality in adult patients who had sepsis ,septic shock ,compare it with established known scoring systems: Sequential Organ Failure Assessment (SOFA), , Acute Physiology ,Chronic Health Evaluation II( APACHE II).
Methods: This prospective cohort research was performed on 74 patients at medical ICU. Demographics, comorbidities, laboratory values, severity scores were collected within 24 hours of admission. LAR was evaluated using lactate (mmol/L) divided by albumin (g/dL).
Results: Non-survivors had higher lactate (3.0 vs 2.35 mmol/L, p=0.001), LAR (1.3 vs 0.9, p=0.001), bilirubin (0.70 vs 0.42 mg/dL, p=0.027), SOFA (7 vs 4, p=0.001), and APACHE II scores (26.0 vs 16.8, p=0.001). They required more vasopressors (65.8% vs 13.9%, p=0.001) and ventilation (21.1% vs 0%, p=0.004). LAR demonstrated fair predictive ability (AUC 0.74, cutoff 1.11, sensitivity 71%, specificity 75%), comparable to lactate (AUC 0.78), but inferior to SOFA (AUC 0.88) and APACHE II (AUC 0.86). In multivariate analysis, SOFA remained only independent predictor of mortality (OR 2.59, 95% CI 1.52–4.39, p=0.0004). Elevated LAR correlated positively with bilirubin, vasopressor, ventilator use, cardiovascular failure, and septic shock (all p<0.05). Patients with LAR >1.
Conclusion: LAR is a simple, inexpensive, readily available biomarker that provides moderate predictive value for mortality in septic ICU patients, reflecting both metabolic stress and systemic inflammation.
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