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Lactate to Albumin Ratio and Mortality in Patients with Severe Coronavirus Disease-2019 Admitted to an Intensive Care

Stelios Kokkoris¹, Aikaterini Gkoufa¹, Dimitrios E Katsaros¹

¹First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens Medical School, Evangelismos Hospital, 45-47 Ipsilantou Street, 10676 Athens, Greece.

Journal of Clinical Medicine

|December 17, 2024

Insights

The lactate/albumin ratio effectively predicts intensive care unit (ICU) mortality in severe Coronavirus Disease-2019 (COVID-19) patients. This biomarker offers more accurate prognostic insights than lactate alone for critical care outcomes.

Area of Science:

Critical Care Medicine
Infectious Diseases
Biomarker Research

Background:

Severe Coronavirus Disease-2019 (COVID-19) poses a significant threat to critically ill patients.
Accurate prediction of intensive care unit (ICU) mortality is crucial for managing these patients.
Existing biomarkers may have limitations in predicting outcomes for COVID-19 patients.

Purpose of the Study:

To evaluate the effectiveness of the lactate/albumin ratio for predicting ICU mortality in severe COVID-19.
To compare the prognostic performance of the lactate/albumin ratio against lactate alone.

Main Methods:

Retrospective cohort study of 805 critically ill COVID-19 patients admitted to an academic ICU.
Analysis of laboratory parameters, including lactate/albumin ratio, on the first day of ICU admission.
Survival analysis and multivariable analysis to assess the association with ICU mortality.

Main Results:

ICU mortality was 48%; higher lactate/albumin ratios were significantly associated with lower survival rates (Log Rank p < 0.001).
Lactate/albumin ratio was an independent risk factor for ICU mortality (Hazard Ratio: 1.39; 95% CI: 1.27-1.52).
The lactate/albumin ratio demonstrated superior predictive performance (ROC-AUC: 0.71) compared to lactate alone (ROC-AUC: 0.68).

Conclusions:

The lactate/albumin ratio is a reliable prognostic marker for critically ill COVID-19 patients.
This ratio predicts ICU mortality more accurately than lactate alone.
The lactate/albumin ratio's predictive value was consistent across various patient subgroups.

Read full analysis

Abstract:

Aim: This study sought to evaluate the effectiveness of lactate/albumin ratio for ICU mortality prediction in a large cohort of patients with severe Coronavirus Disease-2019 (COVID-19) admitted to an intensive care unit (ICU). Methods: This is a single-center retrospective cohort study of prospectively collected data derived from the COVID-19 dataset for all critically ill patients admitted to an academic ICU. Data were used to determine the relation between lactate/albumin ratio and other laboratory parameters measured on the first day of the ICU stay and to evaluate the prognostic performance for ICU mortality prediction. Results: A total of 805 ICU patients were included, and the median age (IQR) was 67 (57-76) years, with 68% being male. ICU mortality was 48%, and the median lactate/albumin ratio was 0.53 (0.39-0.59). A survival analysis showed that patients with higher lactate/albumin ratio values had significantly lower survival rates (Log Rank p < 0.001). A multivariable analysis revealed that the lactate/albumin ratio was an independent risk factor for ICU mortality with a hazard ratio of 1.39 (CI: 1.27-1.52). The lactate/albumin ratio showed a receiver operating characteristics area under the curve (ROC-AUC) value to predict ICU mortality significantly higher than that of lactate alone (0.71 vs. 0.68, DeLong test p < 0.001). The optimal lactate/albumin ratio cut-off for predicting ICU mortality was 0.57, with 63% sensitivity and 73% specificity. A subgroup analysis revealed that the lactate/albumin ratio was significantly associated with mortality across different patient groups, including age and sex categories, and those with or without hypertension and coronary heart disease. Conclusions: Lactate/albumin ratio is a reliable prognostic marker in critically ill COVID-19 patients and could predict ICU mortality more accurately than lactate alone.

Keywords:

COVID-19 SARS-CoV-2 albumin intensive care unit lactate outcome sepsis

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