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.

Keywords: COVID-19, lactate/albumin ratio, lactate, albumin, mortality, predictor

References

  1. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054-62.
  2. Skegg D, Gluckman P, Boulton G, Hackmann H, Karim SSA, Piot P, et al. Future scenarios for the COVID-19 pandemic. Lancet 2021;397:777-8.
  3. Gao YD, Ding M, Dong X, Zhang JJ, Kursat Azkur A, Azkur D, et al. Risk factors for severe and critically ill COVID-19 patients: A review. Allergy 2021;76:428-55.
  4. Ye L, Chen B, Wang Y, Yang Y, Zeng J, Deng G, et al. Prognostic value of liver biochemical parameters for COVID-19 mortality. Ann Hepatol 2021;21:100279.
  5. Gharipour A, Razavi R, Gharipour M, Modarres R, Nezafati P, Mirkheshti N. The incidence and outcome of severe hyperlactatemia in critically ill patients. Intern Emerg Med 2021;16:115-23.
  6. Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, et al. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med 2016;42:202-10.
  7. Lee SG, Song J, Park DW, Moon S, Cho HJ, Kim JY, et al. Prognostic value of lactate levels and lactate clearance in sepsis and septic shock with initial hyperlactatemia: A retrospective cohort study according to the Sepsis-3 definitions. Medicine (Baltimore) 2021;100:e24835.
  8. Velavan TP, Kieu Linh LT, Kreidenweiss A, Gabor J, Krishna S, Kremsner PG. Longitudinal Monitoring of Lactate in Hospitalized and Ambulatory COVID-19 Patients. Am J Trop Med Hyg 2021;104:1041-4.
  9. Kendall H, Abreu E, Cheng AL. Serum Albumin Trend Is a Predictor of Mortality in ICU Patients With Sepsis. Biol Res Nurs 2019;21:237-44.
  10. Gharipour A, Razavi R, Gharipour M, Mukasa D. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am J Emerg Med 2020;38:2088-95.
  11. Kasapoglu US, Arinc S, Gungor S, Irmak I, Guney P, Aksoy F, et al. Prognostic factors affecting survival in non-small cell lung carcinoma patients with malignant pleural effusions. Clin Respir J 2016;10:791-9.
  12. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low Albumin Levels Are Associated with Mortality Risk in Hospitalized Patients. Am J Med 2017;130:1465 e11-e19.
  13. Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care 2020;24:255.
  14. Alhazzani W, Moller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020;46:854-87.
  15. Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y, et al. Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol 2020;92:2152-8.
  16. Violi F, Cangemi R, Romiti GF, Ceccarelli G, Oliva A, Alessandri F, et al. Is Albumin Predictor of Mortality in COVID-19? Antioxid Redox Signal 20201;35:139-42.
  17. Paliogiannis P, Mangoni AA, Cangemi M, Fois AG, Carru C, Zinellu A. Serum albumin concentrations are associated with disease severity and outcomes in coronavirus 19 disease (COVID-19): a systematic review and meta-analysis. Clin Exp Med 2021;21:343-54.
  18. Lichtenauer M, Wernly B, Ohnewein B, Franz M, Kabisch B, Muessig J, et al. The Lactate/Albumin Ratio: A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU. Int J Mol Sci 2017;18.
  19. Shin J, Hwang SY, Jo IJ, Kim WY, Ryoo SM, Kang GH, et al. Prognostic Value of The Lactate/Albumin Ratio for Predicting 28-Day Mortality in Critically ILL Sepsis Patients. Shock 2018;50:545-50.
  20. Bou Chebl R, Jamali S, Sabra M, Safa R, Berbari I, Shami A, et al. Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department. Front Med (Lausanne) 2020;7:550182.
  21. Kong T, Chung SP, Lee HS, Kim S, Lee J, Hwang SO, et al. The Prognostic Usefulness of the Lactate/Albumin Ratio for Predicting Clinical Outcomes in Out-of-Hospital Cardiac Arrest: a Prospective, Multicenter Observational Study (koCARC) Study. Shock 2020;53:442-51.
  22. Guo W, Zhao L, Zhao H, Zeng F, Peng C, Guo W, et al. The value of lactate/albumin ratio for predicting the clinical outcomes of critically ill patients with heart failure. Ann Transl Med 2021;9:118.
  23. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol 2021;31:1-10.
  24. Ji P, Zhu J, Zhong Z, Li H, Pang J, Li B, et al. Association of elevated inflammatory markers and severe COVID-19: A meta-analysis. Medicine (Baltimore) 2020;99:e23315.
  25. Ferrando-Vivas P, Doidge J, Thomas K, Gould DW, Mouncey P, Shankar-Hari M, et al. Prognostic Factors for 30-Day Mortality in Critically Ill Patients With Coronavirus Disease 2019: An Observational Cohort Study. Crit Care Med 2021;49:102-11.
  26. Gavin W, Campbell E, Zaidi SA, Gavin N, Dbeibo L, Beeler C, et al. Clinical characteristics, outcomes and prognosticators in adult patients hospitalized with COVID-19. Am J Infect Control 2021;49:158-65.
  27. Hu J, Wang Y. The Clinical Characteristics and Risk Factors of Severe COVID-19. Gerontology 2021:1-12.
  28. Peiro OM, Carrasquer A, Sanchez-Gimenez R, Lal-Trehan N, Del-Moral-Ronda V, Bonet G, et al. Biomarkers and short-term prognosis in COVID-19. Biomarkers 2021;26:119-26.
  29. Huang W, Li C, Wang Z, Wang H, Zhou N, Jiang J, et al. Decreased serum albumin level indicates poor prognosis of COVID-19 patients: hepatic injury analysis from 2,623 hospitalized cases. Sci China Life Sci 2020;63:1678-87.
  30. Bassoli C, Oreni L, Ballone E, Foschi A, Perotti A, Mainini A, et al. Role of serum albumin and proteinuria in patients with SARS-CoV-2 pneumonia. Int J Clin Pract 2021;75:e13946.
  31. Wang Z, Wang Z. Identification of risk factors for in-hospital death of COVID - 19 pneumonia -- lessions from the early outbreak. BMC Infect Dis 2021;21:113.
  32. Vassiliou AG, Jahaj E, Ilias I, Markaki V, Malachias S, Vrettou C, et al. Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study. Metabolites 2020;10.
  33. 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;30:271-5.

Copyright and license

Copyright © 2021 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Gök A, Kasapoğlu US, Delen LA, Özmen F, Banazılı S. Lactate/Albumin Ratio as a Prognostic Factor for Short-time Mortality in Critically Ill Patients with Coronavirus Disease-2019. Turk J Intensive Care. 2021;19:62-72. https://doi.org/10.4274/tybd.galenos.2021.37167