Lactate to Albumin Ratio for Predicting Clinical Outcomes after In-Hospital Cardiac Arrest

Abstract

In-hospital cardiac arrest (IHCA) is associated with high mortality and poor neurological outcomes. Our objective was to assess whether the lactate-to-albumin ratio (LAR) can predict the outcomes in patients after IHCA. We retrospectively screened 75,987 hospitalised patients at a university hospital between 2015 and 2019. The primary endpoint was survival at 30-days. Neurological outcomes were assessed at 30 days using the cerebral performance category scale. 244 patients with IHCA and return of spontaneous circulation (ROSC) were included in this study and divided into quartiles of LAR. Overall, there were no differences in key baseline characteristics or rates of pre-existing comorbidities among the LAR quartiles. Patients with higher LAR had poorer survival after IHCA compared to patients with lower LAR: Q1, 70.4% of the patients; Q2, 50.8% of the patients; Q3, 26.2% of the patients; Q4, 6.6% of the patients (p = 0.001). Across increasing quartiles, the probability of a favourable neurological outcome in patients with ROSC after IHCA decreased: Q1: 49.2% of the patients; Q2: 32.8% of the patients; Q3: 14.7% of the patients; Q4: 3.2% of the patients (p = 0.001). The AUCs for predicting 30-days survival using the LAR were higher as compared to using a single measurement of lactate or albumin. The prognostic performance of LAR was superior to that of a single measurement of lactate or albumin for predicting survival after IHCA.

The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest

“…[37] Furthermore, compared with OHCA patients, IHCA patients had higher CRP and lower albumin levels, which correlated with patient outcomes. [8,32] Therefore, the distinctive high CRP and low albumin levels in IHCA patients, as opposed to those in OHCA patients, may be indicative of prognosis, aligning with the findings of the present study.…”

“…The albumin level demonstrated an AUC of 0.663 (95% CI: 0.600-0.722; P= 0.004) for predicting favorable neurological outcomes. [32] CAR, a novel marker of systemic inflammation, has been associated with clinical prognoses in various diseases. [33,34] In patients with stable angina pectoris, a high CAR was linked to significant coronary artery disease.…”

Usefulness of lactate to albumin ratio for predicting in-hospital mortality in atrial fibrillation patients admitted to the intensive care unit: a retrospective analysis from MIMIC-IV database

“…Wang et al reported LAR was significantly associated with 14-day, 28-day and 90-day all-cause mortality in critical patients with acute myocardial infarction [ 16 ]. Haschemi et al [ 17 ]. used this indicator to predict survival at 30-days in patients with in-hospital cardiac arrest and found that the prognostic performance of LAR was superior to that of a single measurement of lactate or albumin for predicting survival after in-hospital cardiac arrest.…”