Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt

Özet

This study aimed at investigating the lactate to albumin ratio, as a newlyintroduced biomarker of multiple organ dysfunction syndrome (MODS) andmortality compared to the classic lactate clearance in pediatric patients. Wedesigned a prospective cohort study and 155 patients with severe sepsisor septic shock admitted to a Pediatric Intensive Care Unit were included,starting from January 2016 to March 2017. The data of 119 patients whocompleted the study, were analyzed. Results revealed that lactate clearance(6h, 24h) was significantly lower and lactate/albumin ratio (0h, 6h, 24h) wassignificantly higher in patients who developed MODS and in those who passedaway. The univariate logistic regression showed that both lactate clearanceand lactate/albumin ratio were significant prognostic factors of MODS andmortality. According to the AUC, lactate/albumin ratio (0h, 6h, 24h) showedbetter discrimination of MODS development (with AUC of 0.729, 0.814, and0.819, respectively) compared to lactate clearance (6h, 24h; AUC of 0.738,and 0.672, respectively). Again the lactate/albumin ratio (0h, 6h, 24h) showedbetter discriminatory power of mortality (0.681, 0.741, and 0.856, respectively)compared to the lactate clearance (6h, 24h; 0.638 and 0.77, respectively). TheYouden Index specified a lactate/albumin ratio (0h, 6h, 24h) of 1.17, 1.07,and 1.1 to be the cut-off discriminating values, respectively. The Kaplan-Meiercurves revealed that the cumulative of survival is significantly better for thegroup of patients with a lactate/albumin ratio less than the cut-off values. Itwas concluded that lactate/albumin ratio is a better discriminator of MODSdevelopment and mortality than lactate clearance in pediatric patients withsevere sepsis or septic shock.