Lactate/Albumin Ratio as a Prognostic Factor for Short-time Mortality in Critically Ill Patients with Coronavirus Disease-2019

Abstract

Objective: The prognostic role of the initial lactate/albumin ratio (LAR) in critically ill patients with coronavirus disease-2019 (COVID-19) remains unknown. This study aimed to evaluate the prognostic value of the initial LAR in predicting 30-day mortality in critically ill patients with COVID-19 and compare the initial level of serum lactate and albumin for mortality prediction. Materials and Methods: A single-center and observational clinical study between April 2020 and December 2020 were retrospectively performed. Clinical and laboratory variables of patients evaluated in this study were collected within the first 24 hours following the intensive care unit (ICU) admission. Results: A total of 282 critically ill patients with COVID-19 were included in the study. The mean age of the patients was 66.34±12.08 years, wherein 179 (63.5%) were male. Patients who died within 30 days had higher lactate (p<0.001), lower serum albumin (p<0.001), and higher LAR levels (p<0.001). ROC analysis revealed that LAR (AUC: 0.824) was superior to the serum albumin (AUC: 0.644) and lactate levels (AUC: 0.795) for mortality prediction. Overall ICU mortality rates (75.6% vs. 13.1%, p<0.001) were significantly higher in patients with LAR of >0.60. Conclusion: LAR is a useful prognostic factor for risk stratification of critically ill patients with COVID-19.

Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients

“…16 Gök et al, in an intensive care study in which they investigated the relationship between lactate/albumin ratio and short-term mortality, showed that lactate/albumin ratio could be used as a prognostic factor in SARS-CoV-2infected patients with an AUC value of 0.824. 17 Although there was a difference between the mortality and survivor groups in terms of lactate/albumin ratio as a result of the univariate test, lactate/albumin ratio had the lowest AUC value of 0.641 in the ROC analysis, indicating that it could not be accepted as a good predictor. 6 The first and main limitation of our study was that it was designed retrospectively.…”

Biomarkers and sepsis severity as predictors of mechanical ventilation and mortality in COVID-19

“…Recently, Gök and colleagues (2021) evaluated the L/A ratio in patients with COVID-19, reporting its superior diagnostic accuracy for predicting 30-day mortality compared to lactate and albumin alone [ 17 ]. In our study, we observed that patients with sepsis exhibited higher serum albumin and platelet levels than those with septic shock.…”

“…Non-survivors exhibited higher lactate levels (2.77 vs. 1.73 mmol/L, p < 0.001) and lower albumin levels (2.73 vs. 2.95 g/dL, p < 0.001) compared to survivors. The L/A ratio had an AUC of 0.824 (p < 0.001), surpassing serum albumin levels (AUC = 0.644) and serum lactate levels (AUC = 0.795) [ 17 ]. Patients with an L/A ratio >0.60 upon ICU admission had organ failure and higher APACHE-II scores (p < 0.001), establishing it as an independent 30-day mortality risk factor (HR = 10.615, p < 0.001, 95% CI [5.673, 19.865]).…”