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Prognostic Value of Albumin-to-Fibrinogen Ratio for 28-Day Mortality among Patients with Sepsis from Various
Shuai Li1,2, Yawei Shen1,2, Bowen Chang3
1Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China.
Purpose:
This study investigated the prognostic value of the albumin-to-fibrinogen ratio (AFR) in patients with sepsis as a consequence of infection at various sites.
Methods:
A total of 300 patients with sepsis caused by various infection sites, who met the diagnostic criteria for sepsis hospitalized in the intensive care unit, were enrolled in this study. The observational endpoint was 28-day mortality. Cox proportional hazard regression analysis was performed to determine the potential prognostic factors for 28-day mortality in these septic patients. Receiver operating characteristic (ROC) curve analysis was used to evaluate and compare the prognostic factors for 28-day mortality.
Results:
Of 300 participants, 147 died, corresponding to a 28-day mortality of 49% (147/300). Baseline Acute Physiology and Chronic Health Evaluation (APACHE II) score (hazard ratio (HR) 1.18 (95% confidence interval (CI) 1.07-1.30); P < 0.001), baseline lactic acid level (HR 1.27 (95% CI 1.08-1.50); P = 0.005), the presence of septic shock (HR 21.44 (95% CI 2.51-182.76); P = 0.005), and baseline AFR (HR 0.70 (95% CI 0.62-0.80); P < 0.001) were independent prognostic factors for 28-day mortality in patients with sepsis according to multivariate Cox analysis. Baseline AFR was an effective predictor of 28-day mortality, with an area under the ROC curve (AUC) of 0.700, and a specificity and sensitivity of 90.8% and 42.1%, respectively. A low baseline AFR level was associated with increased 28-day sepsis-related mortality. The quadruple index, which included the APACHE II score, lactic acid, septic shock, and AFR, showed a more accurate predictive value for septic patients than the APACHE II score, lactic acid, septic shock, and AFR alone, with an AUC of 0.922, and specificity and sensitivity of 86.9% and 83.6%, respectively. Moreover, the triple index, which included the APACHE II score, lactic acid, and septic shock, showed a significantly lower prognostic value for 28-day mortality compared with the ROC curve of the quadruple index and triple index, with an AUC of 0.877 and specificity and sensitivity of 77.8% and 82.3%, respectively.
Conclusions:
The results of this study demonstrate that AFR is an independent protective factor for predicting 28-day mortality in patients with sepsis due to various infection sites. AFR combined with the APACHE II score, lactic acid, and septic shock showed a higher prognostic value for sepsis prognosis.
Insights
The albumin-to-fibrinogen ratio (AFR) is a protective factor for sepsis mortality. Combining AFR with APACHE II score, lactic acid, and septic shock improves sepsis prognosis prediction.
Area of Science:
- Critical Care Medicine
- Biochemistry
- Clinical Pathology
Background:
- Sepsis remains a leading cause of mortality worldwide, necessitating improved prognostic tools.
- Identifying reliable biomarkers for predicting sepsis outcomes is crucial for timely clinical intervention.
Purpose of the Study:
- To investigate the prognostic value of the albumin-to-fibrinogen ratio (AFR) in patients with sepsis.
- To assess the predictive accuracy of AFR, alone and in combination with other clinical factors, for 28-day mortality in sepsis patients.
Main Methods:
- A cohort of 300 sepsis patients from various infection sites were enrolled.
- Cox proportional hazard regression and Receiver Operating Characteristic (ROC) curve analyses were employed.
- Key prognostic factors evaluated included APACHE II score, lactic acid, septic shock, and baseline AFR.
Main Results:
- The 28-day mortality rate was 49% (147/300).
- Baseline AFR was an independent protective factor for 28-day mortality (HR 0.70, P < 0.001), with an AUC of 0.700.
- A combination index (APACHE II, lactic acid, septic shock, AFR) demonstrated superior predictive value (AUC 0.922) compared to individual factors.
Conclusions:
- AFR is a significant independent protective factor for predicting 28-day mortality in sepsis patients.
- Combining AFR with APACHE II score, lactic acid, and septic shock enhances prognostic accuracy for sepsis.
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