J Korean Soc Emerg Med.  2019 Feb;30(1):22-32. 10.0000/jksem.2019.30.1.22.

Lactate/albumin ratio for the prediction of the development of sepsis-induced acute kidney injury in the emergency department

Affiliations
  • 1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea. grampian@yuhs.ac
  • 2Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon, Korea.
  • 3Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
The early prediction of acute kidney injury (AKI) in sepsis and the provision of prompt treatment may improve the outcomes. This study investigated the efficacy of the lactate/albumin ratio (LAR) in predicting severe AKI in cases of septic shock.
METHODS
This retrospective, observational cohort study was performed on patients integrated prospectively in a critical pathway of early-goal-directed therapy (EGDT)/SEPSIS. Adult patients with septic shock, who were admitted to the emergency department with a normal kidney function or stage 1 disease based on the Acute Kidney Injury Network classification between January 1, 2014 and September 30, 2017, were analyzed. The outcomes were the development of sepsis-induced severe AKI within 7 days.
RESULTS
A total of 343 patients were enrolled. An increase in the LAR value at admission (odds ratio [OR], 1.85; P=0.001) was a strong independent predictor of the development of severe AKI. The increasing predictability of AKI was closely associated with a L/A ratio≥0.794 at admission (OR, 14.66; P < 0.001). The area under the receiver operating characteristic curve value of the L/A ratio (0.821; 95% confidence interval [CI], 0.774-0.861; P < 0.01) was higher than that of lactate (0.795; 95% CI, 0.747-0.838; P < 0.01) for predicting severe AKI (P=0.032).
CONCLUSION
L/A ratio was found to be an independent predictor of the development of severe AKI in septic shock. The prognostic performance of the L/A ratio for predicting AKI of critically ill sepsis patients was superior to that of lactate measurements.

Keyword

Sepsis; Acute kidney injury; Lactic acid; Albumins; Prognosis

MeSH Terms

Acute Kidney Injury*
Adult
Albumins
Classification
Cohort Studies
Critical Illness
Critical Pathways
Emergencies*
Emergency Service, Hospital*
Humans
Kidney
Lactic Acid
Prognosis
Prospective Studies
Retrospective Studies
ROC Curve
Sepsis
Shock, Septic
Albumins
Lactic Acid
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