Prognostic Value of Albumin-to-Fibrinogen Ratio for 28-Day Mortality among Patients with Sepsis from Various Infection Sites

Abstract

Purpose. This study investigated the prognostic value of the albumin-to-fibrinogen ratio (AFR) in patients with sepsis as a consequence of infection at various sites. Methods. A total of 300 patients with sepsis caused by various infection sites, who met the diagnostic criteria for sepsis hospitalized in the intensive care unit, were enrolled in this study. The observational endpoint was 28-day mortality. Cox proportional hazard regression analysis was performed to determine the potential prognostic factors for 28-day mortality in these septic patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate and compare the prognostic factors for 28-day mortality. Results. Of 300 participants, 147 died, corresponding to a 28-day mortality of 49% (147/300). Baseline Acute Physiology and Chronic Health Evaluation (APACHE II) score (hazard ratio (HR) 1.18 (95% confidence interval (CI) 1.07–1.30); P < 0.001 ), baseline lactic acid level (HR 1.27 (95% CI 1.08–1.50); P = 0.005 ), the presence of septic shock (HR 21.44 (95% CI 2.51–182.76); P = 0.005 ), and baseline AFR (HR 0.70 (95% CI 0.62–0.80); P < 0.001 ) were independent prognostic factors for 28-day mortality in patients with sepsis according to multivariate Cox analysis. Baseline AFR was an effective predictor of 28-day mortality, with an area under the ROC curve (AUC) of 0.700, and a specificity and sensitivity of 90.8% and 42.1%, respectively. A low baseline AFR level was associated with increased 28-day sepsis-related mortality. The quadruple index, which included the APACHE II score, lactic acid, septic shock, and AFR, showed a more accurate predictive value for septic patients than the APACHE II score, lactic acid, septic shock, and AFR alone, with an AUC of 0.922, and specificity and sensitivity of 86.9% and 83.6%, respectively. Moreover, the triple index, which included the APACHE II score, lactic acid, and septic shock, showed a significantly lower prognostic value for 28-day mortality compared with the ROC curve of the quadruple index and triple index, with an AUC of 0.877 and specificity and sensitivity of 77.8% and 82.3%, respectively. Conclusions. The results of this study demonstrate that AFR is an independent protective factor for predicting 28-day mortality in patients with sepsis due to various infection sites. AFR combined with the APACHE II score, lactic acid, and septic shock showed a higher prognostic value for sepsis prognosis.

Fibrinogen reflects severity and predicts outcomes in patients with sepsis and septic shock

“…However, no multivariable risk prediction models were performed in the study by Li et al [36]. In contrast to the study by Li et al [36], specifically low fibrinogen levels were associated with adverse outcomes in the present study, whereas Li et al [36] increased fibrinogen levels during acute phase as predictor of short-term mortality. Despite the controversial pathophysiological patterns of fibrinogen including possible increase during acute phase and decrease as a result of SIC-related fibrinogen consumption at advanced stages of sepsis, the AFR may not an appropriate tool in patients with more advanced stages of sepsis [8,26].…”

“…Specifically, after multivariable adjustment the AFR was no longer associated with the risk of 30-day all-cause mortality. However, no multivariable risk prediction models were performed in the study by Li et al [36]. In contrast to the study by Li et al [36], specifically low fibrinogen levels were associated with adverse outcomes in the present study, whereas Li et al [36] increased fibrinogen levels during acute phase as predictor of short-term mortality.…”

“…The prognostic impact of the AFR was investigated within 246 patients who underwent surgical treatment for peritonitis-induced sepsis and revealed reliable prognostic accuracy for prediction of 28-day all-cause mortality (AUC 0.751) [14]. In line with this, Li et al [36] demonstrated baseline AFR was an independent predictor of 28-day all-cause mortality (AUC 0.700) in 300 patients with sepsis irrespective of Prognostic impact of fibrinogen and the albumin-fibrinogen-ratio with regard to 30-day all-cause mortality in patients admitted with sepsis and septic shock.…”

“…The prognostic impact of the AFR was investigated within 246 patients who underwent surgical treatment for peritonitis-induced sepsis and revealed reliable prognostic accuracy for prediction of 28-day all-cause mortality (AUC 0.751) [14]. In line with this, Li et al [36] demonstrated baseline AFR was an independent predictor of 28-day all-cause mortality (AUC 0.700) in 300 patients with sepsis irrespective of infection site, which was superior as compared to albumin (AUC 0.631) and fibrinogen (AUC 0.649) alone but inferior to lactate acid and the APACHE II score. The present study demonstrates superior prognostic accuracy for fibrinogen alone as compared to the AFR.…”

Does Albumin Predict the Risk of Mortality in Patients with Cardiogenic Shock?

“…The albumin concentration is affected by various conditions, including endogenous synthesis, distribution, exogenous albumin loss, and hemodilution. Similarly, albumin synthesis may be impaired by concomitant liver disease, nutrition status, infection, and specifically in sepsis [ 26 , 27 , 28 , 29 ]. In patients suffering from AMI, adverse outcomes of patients with low albumin levels may be attributed to higher rates of older patients with consecutively increased rates of malnutrition and cachexia, reflected by lower cholesterol and lymphocyte levels in prior studies [ 22 ].…”