The profile of lactate, albumin, and lactate/albumin ratio as predictors of mortality in sepsis patients

Cover Page


Cite item

Full Text

Abstract

Background. Oxygenation disturbances in sepsis patients may cause lactate levels increase which is proportional to the severity of the inflammation, followed by decrease in albumin levels. Combination of these two parameters is expected to be predictor of mortality in patients with sepsis. The aim of this study is to investigate the profile of lactate, albumin, and lactate/albumin ratio as mortality predictors in patient with sepsis. Methods. This prospective cohort study was conducted in the ICU of dr. Saiful Anwar Hospital, Malang, from January to May 2019. Subjects were 82 patients with sepsis (SOFA score > 2). Lactate and albumin levels were measured on the first day of hospitalization. Lactate levels were examined by colorimetric method, albumin was examined by BCG method. The instrument used was Cobas 501. Comparation was carried out using the T-Test/Mann–Whitney test. Prediction of mortality risk was done using relative risk (RR) determination. Results. Significant difference was observed in albumin levels between sepsis patients who survived and who died (p = 0.045). No significant differences were observed in lactate levels and lactate/albumin ratio between sepsis patients who survived and who died (p = 0.211, 0.119, respectively). Relative risks were 3.034 for lactate, 3.667 for albumin, and 4.400 for lactate/albumin ratio. Conclusion. In patients with sepsis, albumin level is the best variable in predicting mortality, followed by lactate/albumin ratio and lactate value. Further study that implements repeated measurement of lactate and albumin in 6 and 12 hours is required to better predict the mortality of sepsis patients.

About the authors

A. Iskandar

Universitas Brawijaya; Dr. Saiful Anwar General Hospital

Email: fake@neicon.ru

Clinical Pathologist, Department of Clinical Pathology, Faculty of Medicine, Universitas Brawijaya; Dr. Saiful Anwar General Hospital.

Malang.

Индонезия

M. I. Vincentia

Airlangga University

Email: fake@neicon.ru

Clinical Pathologist, Faculty of Medicine, Airlangga University.

Surabaya.

Индонезия

W. Jaya

Universitas Brawijaya; Dr. Saiful Anwar General Hospital

Email: fake@neicon.ru

Anaesthesiologist, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Brawijaya; Dr. Saiful Anwar General Hospital.

Malang.

Индонезия

A. Aryati

Airlangga University; Dr. Soetomo General Hospital

Email: fake@neicon.ru

PhD, MD (Medicine), Professor of Clinical Pathology, Department of Clinical Pathology, Faculty of Medicine, Airlangga University; Dr. Soetomo General Hospital.

Surabaya.

Индонезия

A. Pramadhani

Universitas Brawijaya

Email: fake@neicon.ru

Student, Faculty of Medicine, Universitas Brawijaya.

Malang.

Индонезия

A. Aprilia

Universitas Brawijaya

Author for correspondence.
Email: andreaaprilia134@gmail.com
ORCID iD: 0000-0002-9732-9878

Andrea Aprilia - Clinical Pathologist, Department of Clinical Pathology, Faculty of Medicine, Universitas Brawijaya; Dr. Saiful Anwar General Hospital.

65145, East Java, Malang, Lowokwaru, Veteran str.

Phone: +62 (8577) 400-90-60

Индонезия

References

  1. Garcia-Alvarez M., Marik P., Bellomo R. Sepsis-associated hyperlactatemia. Crit. Care, 2014, vol. 18, no. 5: 503. doi: 10.1186/s13054-014-0503-3
  2. Gupta L., James B.S. Hypoalbuminemia as a prognostic factor in sepsis, severe sepsis and septic shock. Crit. Care Med., 2012, vol. 40: 727. doi: 10.1097/01.ccm.0000424942.33592.72
  3. Haas S.A., Lange T., Saugel B., Petzoldt M., Fuhrmann V., Metschke M., Kluge S. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med., 2016, vol. 42, no. 2, pp. 202–210. doi: 10.1007/s00134-015-4127-0
  4. Hasegawa D., Nishida K., Hara Y., Kawaji T., Moriyama K., Shimomura Y., Niimi D., Komura H., Nishida O. Differential effect of lactate in predicting mortality in septic patients with or without disseminated intravascular coagulation: a multicenter, retrospective, observational study. J. Intens. Care., 2019, vol. 7: 2. doi: 10.1186/s40560-019-0389-x
  5. Kendall H., Abreu E., Cheng A.L. Serum albumin trend is a predictor of mortality in ICU patients with Sepsis. Biol. Res. Nurs., 2019, vol. 21, no. 3, pp. 237–244. doi: 10.1177/1099800419827600
  6. Lee S.W., Hong Y., Park D., Choi S.H., Moon S., Park J.S., Kim J.Y., Baek K.J. Lactic acidosis not hyperlactatemia as a predictor of inhospital mortality in septic emergency patients. Emerg. Med. J., 2008, vol. 25, no. 10, pp. 659–665. doi: 10.1136/emj.2007.055558
  7. 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, vol. 18, no. 9: 1893. doi: 10.3390/ijms18091893
  8. Magnussen B., Oren Gradel K., Gorm Jensen T., Kolmos H.J., Pedersen C., Just Vinholt P., Touborg Lassen A. Association between hypoalbuminaemia and mortality in patients with community-acquired bacteraemia is primarily related to acute disorders. PLoS One, 2016, vol. 11, no. 9: e0160466. doi: 10.1371/journal.pone.0160466
  9. Mikkelsen M.E., Miltiades A.N., Gaieski D.F., Goyal M., Fuchs B.D., Shah C.V., Bellamy S.L., Christie J.D. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit. Care Med., 2009, vol. 37, no. 5, pp. 1670– 1677. doi: 10.1097/CCM.0b013e31819fcf68
  10. Nguyen H.B., Rivers E.P., Knoblich B.P., Jacobsen G., Muzzin A., Ressler J.A., Tomlanovich M.C. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit. Care Med., 2004, vol. 32, no. 8, pp. 1637–1642. doi: 10.1097/01.ccm.0000132904.35713.a7
  11. Nichol A., Bailey M., Egi M., Pettila V., French C., Stachowski E., Reade M.C., Cooper D.J., Bellomo R. Dynamic lactate indices as predictors of outcome in critically ill patients. Crit. Care, 2011, vol. 15, no. 5: R242. doi: 10.1186/cc10497
  12. Nichol A.D., Egi M., Pettila V., Bellomo R., French C., Hart G., Davies A., Stachowski E., Reade M.C., Bailey M., Cooper D.J. Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit. Care, 2010, vol. 14, no. 1: R25. doi: 10.1186/cc8888
  13. Qian S.-Z., Jin D., Chen Z.-B., Ye Y.-C., Xiang W.-W., Ye L.-M., Pan J.-Y. Hypoalbuminemia, a novel prognostic factor for prediction of long-term outcomes in critically ill patients with septic shock. Int. J. Clin. Exp. Med., 2019, vol. 12, no. 6, pp. 7401–7409.
  14. Rhodes A., Evans L.E., Alhazzani W., Levy M.M., Antonelli M., Ferrer R., Kumar A., Sevransky J.E., Sprung C.L., Nunnally M.E., Rochwerg B, Rubenfeld G.D., Angus D.C., Annane D, Beale R.J., Bellinghan G.J., Bernard G.R., Chiche J.D., Coopersmith C., De Backer D.P., French C.J., Fujishima S., Gerlach H., Hidalgo J.L., Hollenberg S.M., Jones A.E., Karnad D.R., Kleinpell R.M., Koh Y., Lisboa T.C., Machado F.R., Marini J.J., Marshall J.C., Mazuski J.E., McIntyre L.A., McLean A.S., Mehta S., Moreno R.P., Myburgh J., Navalesi P., Nishida O., Osborn T.M., Perner A., Plunkett C.M., Ranieri M., Schorr C.A., Seckel M.A., Seymour C.W., Shieh L., Shukri K.A., Simpson S.Q., Singer M., Thompson B.T., Townsend S.R., Van der Poll T., Vincent J.L., Wiersinga W.J., Zimmerman J.L., Dellinger R.P. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med., 2017, vol. 43, no. 3, pp. 304–377. doi: 10.1007/s00134-017-4683-6
  15. Shin J., Hwang S.Y., Jo I.J., Kim W.Y., Ryoo S.M., Kang G.H., Kim K., Jo Y.H., Chung S.P., Joo Y.S., Beom J.H., Yoon Y.H., Han K.S., Lim T.H., Choi H.S., Kwon W.Y., Suh G.J., Choi S.H., Shin T.G.; Korean Shock Society (KoSS) Investigators. Prognostic value of the lactate/albumin ratio for predicting 28-day mortality in critically ill sepsis patients. Shock, 2018, vol. 50, no. 5, pp. 545–550. doi: 10.1097/SHK.0000000000001128
  16. Takegawa R., Kabata D., Shimizu K., Hisano S., Ogura H., Shintani A., Shimazu T. Serum albumin as a risk factor for death in patients with prolonged sepsis: an observational study. J. Crit. Care, 2019, vol. 51, pp. 139–144. doi: 10.1016/j.jcrc.2019.02.004
  17. Thapa S., Prasad P., Shakya Y. Serum lactate albumin ratio as a predictor of mortality in severe sepsis and septic shock at Tribhuwan University Teaching Hospital, Kathmandu. Birat J. Health Sci., 2017, vol. 2, no. 2, pp. 191–195. doi: 10.3126/bjhs.v2i2.18525
  18. Thomas-Rueddel D.O., Poidinger B., Weiss M., Bach F., Dey K., Häberle H., Kaisers U., Rüddel H., Schädler D., Scheer C., Schreiber T., Schürholz T., Simon P., Sommerer A., Schwarzkopf D., Weyland A., Wöbker G., Reinhart K., Bloos F.; Medical Education for Sepsis Source Control and Antibiotics Study Group. Hyperlactatemia is an independent predictor of mortality and denotes distinct subtypes of severe sepsis and septic shock. J. Crit. Care., 2015, vol. 30, no. 2: 439.e1-6. doi: 10.1016/j.jcrc.2014.10.027
  19. Van Beest P.A., Brander L., Jansen S.P., Rommes J.H., Kuiper M.A., Spronk P.E. Cumulative lactate and hospital mortality in ICU patients. Ann. Intensive Care, 2013, vol. 3, no. 1: 6. doi: 10.1186/2110-5820-3-6
  20. Wang B., Chen G., Cao Y., Xue J., Li J., Wu Y. Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J. Crit. Care, 2015, vol. 30, no. 2, pp. 271–275. doi: 10.1016/j.jcrc.2014.10.030
  21. Yin M., Si L., Qin W., Li C., Zhang J., Yang H., Han H., Zhang F., Ding S., Zhou M., Wu D., Chen X., Wang H. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. Intensive Care Med., 2018, vol. 33, no. 12, pp. 687–694.

Supplementary files

Supplementary Files
Action
1. JATS XML

Copyright (c) 2021 Iskandar A., Vincentia M.I., Jaya W., Aryati A., Pramadhani A., Aprilia A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 64788 от 02.02.2016.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies