The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients.
The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients.
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PICU 患者乳酸白蛋白比与死亡率和多器官功能障碍的关系。
DOI：
10.1097/pcc.0000000000003272
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Patel,AnitaK
中科院分区：
文献类型：
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作者：
Ray,ChristopherC;Pollack,MurrayM;Gai,Jiaxiang;Patel,AnitaK
目的：在危重儿科患者的一般样本中，比较病程早期测得的乳酸盐、白蛋白和乳酸盐-白蛋白比（LAR）与死亡率和多器官功能障碍综合征（MODS）患病率的相关性。设计：回顾性分析Health Facts（Cerner Corporation，堪萨斯城，MO）国家数据库。背景：设有PICU的美国医院。患者：2009年至2018年入住ICU的儿童（n= 648），在入院后6小时内测得乳酸盐和白蛋白。干预：无。测量和主要结果：共纳入648例入院患者，总死亡率为10.8%（n= 70），MODS患病率为29.3%（n= 190）。与幸存者相比，死亡者的初始乳酸水平较高，（7.3 mmol/L [2.6-11.7 mmol/L] vs 1.9 mmol/L [1.2-3.1 mmol/L]; p< 0.01），较低的初始白蛋白（3.3 g/dL [2.7-3.8 g/dL] vs 4.2 g/dL [3.7-4.7 g/dL]; p< 0.01）和更高的LAR（2.2 [1.0-4.2] vs 0.5 [0.3-0.8]; p< 0.01），MODS患者与非MODS患者的趋势相似。LAR组死亡的比值比（OR）高于初始乳酸盐组（2.34 [1.93-2.85] vs 1.29 [1.22-1.38]），MODS的OR高于初始乳酸盐组（2.10 [1.73-2.56] vs 1.22 [1.16-1.29]）。LAR对死亡率的受试者工作特征（AUROC）曲线下面积大于初始乳酸（0.86 vs 0.82; p< 0.01）。MODS的LAR AUROC大于乳酸AUROC（0.71 vs 0.66; p< 0.01）。乳酸，白蛋白，LAR死亡率的趋势是一致的几个诊断亚组（创伤，原发性呼吸衰竭，毒理学），但不是所有的结论：LAR测量早期的危重病过程中显着相关的死亡率和MODS的发展相比，初始乳酸或初始白蛋白单独在重症儿科患者。
OBJECTIVES:To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients.DESIGN:Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database.SETTING:US hospitals with PICUs.PATIENTS:Children admitted to the ICU (n= 648) from 2009 to 2018 who had lactate and albumin measured within 6 hours of admission.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:A total of 648 admissions were included, with an overall mortality rate of 10.8%(n= 70) and a MODS prevalence of 29.3%(n= 190). Compared with survivors, deaths had higher initial lactates (7.3 mmol/L [2.6–11.7 mmol/L] vs 1.9 mmol/L [1.2–3.1 mmol/L]; p< 0.01), lower initial albumins (3.3 g/dL [2.7–3.8 g/dL] vs 4.2 g/dL [3.7–4.7 g/dL]; p< 0.01), and higher LARs (2.2 [1.0–4.2] vs 0.5 [0.3–0.8]; p< 0.01), with similar trends in patients with MODS versus those without MODS. LAR demonstrated a higher odds ratio (OR) for death than initial lactate alone (2.34 [1.93–2.85] vs 1.29 [1.22–1.38]) and a higher OR for MODS than initial lactate alone (2.10 [1.73–2.56] vs 1.22 [1.16–1.29]). Area under the receiver operating characteristic (AUROC) curve of LAR for mortality was greater than initial lactate (0.86 vs 0.82; p< 0.01). The LAR AUROC for MODS was greater than the lactate AUROC (0.71 vs 0.66; p< 0.01). Trends of lactate, albumin, and LAR for mortality were consistent across several diagnostic subgroups (trauma, primary respiratory failure, toxicology), but not all.CONCLUSIONS:LAR measured early in the course of critical illness is significantly associated with mortality and development of MODS when compared with initial lactate or initial albumin alone in critically ill pediatric patients.