Prognostic Value of Lactate / Albumin Ratio Combined with APACHE II, SAPS II and SOFA Score for Predicting Mortality in Critically Ill Patients with Septic Shock

Abstract

Sepsis remains a substantial source of mortality and health care costs worldwide. In the US, the incidence of sepsis has steadily risen at a rate of 13% annually over the past decade and is estimated to carry a significant burden of healthcare in the future. Sepsis-related mortality is reported to be as high as 29.9%. Worldwide, the incidence and mortality associated with sepsis continues to climb. Time is of the essence in the treatment of sepsis; early and aggressive treatment is important to reduce mortality. In 30–50% of patients, sepsis treatment is initiated in the emergency department (ED). Considering that ICU capacity is limited and that not all sepsis patients will benefit from ICU admission, the main challenge that ED physicians face is to effectively stratify patients into patients requiring ICU treatment and patients who can be treated at ward. Incorrect stratification may result in increased morbidity and mortality, and increased length of stay. The lactate/albumin ratio (LAR) has potential benefits for prognostication of sepsis patients. The two markers independently predict mortality, and the values inversely change by different mechanisms. Thus, a combination of the 2 parameters might increase the predictive value. Also, normal or intermediate levels of lactate might be misinterpreted as a good prognosis. The LAR ratio might help identification of high-risk patients. The aim of this study was to evaluate the prognostic performance of the lactate/albumin (L/A) ratio when combined with APACH II score, SOFA score and SAPS II for predicting 28-day mortality in critically ill patients with septic shock In this prospective observational study, after approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, 100 adult patients of both sexes with septic shock were enrolled. Different stratification scores were evaluated directly upon admission besides measuring their LAR. Then, they were categorized into 2 groups according to their 28-days mortality. 64% of them were died (non-survivors group) and 36% were survived (survivors group).