Year 2024 / Volume 116 / Number 10
Original
Comparison of lactate/albumin ratio and established scoring systems for predicting mortality in critically ill cirrhotic patients

539-545

DOI: 10.17235/reed.2024.10450/2024

Nazlıhan Boyacı Dundar, Kamil İnci, Melda Turkoglu, Gulbin Aygencel,

Abstract
Background: critically ill cirrhotic patients may present a serious clinical condition defined as acute-on-chronic liver failure with high mortality. While established scoring systems like Child-Pugh and Model for End-stage Liver Disease (MELD) offer prognostic insights, their limitations warrant exploration of alternative markers. The lactate/albumin ratio (LAR) serves as a potential prognostic indicator in critical care settings, yet its utility in cirrhotic patients remains underexplored. Methods: one hundred and seventy-five critically ill cirrhotic patients were assessed in this retrospective cohort study. Clinical severity scores, including Acute Physiology and Chronic Health Evaluation II (APACHE II), Sequential Organ Failure Assessment (SOFA), and Chronic Liver Failure-Organ Failure Score (CLIF-OF) were compared with LAR along with traditional liver failure scoring systems. Logistic regression and receiver operating characteristic (ROC) curve analysis were used to evaluate prognostic performance. Results: Intensive Care Unit (ICU) nonsurvivors had significantly higher scores in all liver failure and clinical severity scores compared to survivors (p < 0.001). Median LAR was significantly higher in nonsurvivors (p < 0.001). ROC analysis revealed comparable prognostic accuracy between LAR, APACHE II, SOFA, and CLIF-OF scores in predicting ICU mortality. Logistic regression identified SOFA score at 48th hour, LAR, and requirement of mechanical ventilation as independent predictors of ICU mortality. Conclusion: LAR demonstrates promising prognostic utility in predicting ICU mortality among critically ill cirrhotic patients, complementing established scoring systems. Early reassessment using SOFA score at 48th hour may guide therapeutic interventions and improve patient outcomes. Further prospective studies are warranted to validate these findings and optimize clinical management strategies.
Lay Summary
Critically ill cirrhotic patients are a vulnerable population characterized by numerous complications related to advanced liver disease. Assessing the prognosis of these patients is crucial for clinical decision-making due to the increased morbidity and mortality. In recent years, the lactate/albumin ratio has gained attention for short-term mortality in critical care settings. This study aimed to evaluate the prognostic performance of the serum lactate/albumin ratio with established scoring systems in cirrhotic patients and its relationship with clinical severity scores in critically ill patients. For this purpose, a retrospective cohort study was conducted. The serum lactate/albumin ratio demonstrates a promising prognostic use to predict ICU mortality among critically ill cirrhotic patients, complementing established scoring systems. Early reassessment using the Sequential Organ Failure Assessment score at 48th hours may guide therapeutic interventions and improve patient outcomes.
Share Button
New comment
Comments
No comments for this article
References
1- Nusrat S, Khan MS, Fazili J, et al. Cirrhosis and its complications: evidence based treatment. World J Gastroenterol. 2014 May 14;20(18):5442-60.
2- Irvine KM, Ratnasekera I, Powell, et al. Causes and Consequences of Innate Immune Dysfunction in Cirrhosis. Front Immunol. 2019 Feb 25;10:293.
3-Moreau, R., Jalan, R., Gines, P., et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144(7): 1426-1437.
4-Child CG, Turcotte JG. Surgery and portal hypertension. Major Probl Clin Surg. 1964;1:1-85
5-Kamath, P. S., Wiesner, R. H., Malinchoc, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001 Feb;33(2):464-70.
6-Goudsmit BFJ, Putter H, Tushuizen ME, et al. Validation of the model for end-stage liver disease sodium (MELD-Na) score in the Eurotransplant region. Am J Transplant. 2021;21(1):229–40
7-Jalan R, Saliba F, Pavesi M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on chronic liver failure. J Hepatol 2014;61(5):1038–47
8-Yin M, Si L, Qin W, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018;33(12):687–694.
9-Mikkelsen M. E., Miltiades A. N., Gaieski,D. F., et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009 May;37(5):1670-7.
10-Hernández, G., Bellomo, R., Bakker, J., et al. The ten pitfalls of lactate clearance in sepsis. Intensive Care Med. 2019 Jan;45(1):82-85.
11-Krispin I, Mahamid M, Goldin E, et al. Elevated lactate/albumin ratio as a novel predictor of in-hospital mortality in hospitalized cirrhotics. Ann Hepatol. 2023 May-Jun;28(3):100897.
12- Slottosch I, Liakopoulos O, Kuhn E, et al. Lactate and lactate clearance as valuable tool to evaluate ECMO therapy in cardiogenic shock. J Crit Care. 2017 Dec;42:35-41.
13-Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801–810.
14-Ramzan M, Iqbal A, Murtaza HG, et al. Comparison of CLIF-C ACLF Score and MELD Score in Predicting ICU Mortality in Patients with Acute-On-Chronic Liver Failure. Cureus. 2020 Feb 24;12(2):e7087.
15-Olmez S, Gümürdülü Y, Tas A, et al. Prognostic markers in cirrhotic patients requiring intensive care: a comparative prospective study. Ann Hepatol. 2012 Jul-Aug;11(4):513-8.
16-Tsai MH, Chen YC, Ho YP, et al. Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients. J Clin Gastroenterol. 2003 Sep;37(3):251-7.
17-Gharipour A, Razavi R, Gharipour M, et al. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am J Emerg Med. 2020 Oct;38(10):2088-2095.
18-Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand J Clin Lab Invest. 2021 May;81(3):225-229.
19-Nagel M, Westphal R, Hilscher M, et al. Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment. Medicina (Kaunas). 2023 Apr 29;59(5):866.
20- Liu Q, Zheng HL, Wu MM, et al. Association between lactate-to-albumin ratio and 28-days all-cause mortality in patients with acute pancreatitis: A retrospective analysis of the MIMIC-IV database. Front Immunol. 2022 Dec 14;13:1076121.
21- Wang D, Luo C, Li Q, et al. Association between lactate/albumin ratio and all-cause mortality in critical patients with acute myocardial infarction. Sci Rep. 2023 Sep 20;13(1):15561.
22- Li X, Gong M, Fu S, et al. Establishment of MELD-lactate clearance scoring system in predicting death risk of critically ill cirrhotic patients. BMC Gastroenterol. 2022 Jun 3;22(1):280.
23- Gao F, Huang XL, Cai MX, et al. Prognostic value of serum lactate kinetics in critically ill patients with cirrhosis and acute-on-chronic liver failure: a multicenter study. Aging (Albany NY). 2019 Jul 1;11(13):4446-4462.
24-Abdellatif Z, Eletreby R, Samir R, et al. Outcome and prognostic markers of cirrhotic and non-cirrhotic patients admitted to a hepatology ICU in a tertiary care university hospital. Afr Health Sci. 2022 Jun;22(2):377-383.
25-Lecuyer L, Chevret S, Thiery G, et al. The ICU trial: a new admission policy for cancer patients requiring mechanical ventilation. Crit Care Med. 2007 Mar;35(3):808-14.
Related articles

Editorial

Treatment of portal vein thrombosis in cirrhosis patients

DOI: 10.17235/reed.2023.9800/2023

Editorial

AKI-HRS, more than a name change for type-1 hepatorenal syndrome

DOI: 10.17235/reed.2023.9677/2023

Editorial

New actors come into play against hepatitis delta

DOI: 10.17235/reed.2022.9050/2022

Letter

Hemoperitoneum due to rupture of intra-abdominal varices

DOI: 10.17235/reed.2022.8937/2022

Letter

Cirrhotic pattern in advanced hepatic sarcoidosis

DOI: 10.17235/reed.2021.8446/2021

Digestive Diseases Image

Giant cystic hepatocarcinoma in the absence of cirrhosis

DOI: 10.17235/reed.2021.8313/2021

Review

Physical frailty in liver transplantation

DOI: 10.17235/reed.2020.7448/2020

Review

Risk stratification and treatment of primary biliary cholangitis

DOI: 10.17235/reed.2018.5662/2018

Citation tools
Boyacı Dundar N, İnci K, Turkoglu M, Aygencel G. Comparison of lactate/albumin ratio and established scoring systems for predicting mortality in critically ill cirrhotic patients. 10450/2024


Download to a citation manager

Download the citation for this article by clicking on one of the following citation managers:

Metrics
This article has received 361 visits.
This article has been downloaded 45 times.

Statistics from Dimensions


Statistics from Plum Analytics

Publication history

Received: 02/04/2024

Accepted: 02/06/2024

Online First: 14/06/2024

Published: 09/10/2024

Article revision time: 60 days

Article Online First time: 73 days

Article editing time: 190 days


Share
This article hasn't been rated yet.
Reader rating:
Valora este artículo:




Asociación Española de Ecografía Digestiva Sociedad Española de Endoscopia Digestiva Sociedad Española de Patología Digestiva
The Spanish Journal of Gastroenterology is the official organ of the Sociedad Española de Patología Digestiva, the Sociedad Española de Endoscopia Digestiva and the Asociación Española de Ecografía Digestiva
Cookie policy Privacy Policy Legal Notice © Copyright 2023 y Creative Commons. The Spanish Journal of Gastroenterology