Abstract：
The prognostic evaluation of the septic patient has recently been enriched by some predictive indices such as albumin concentration, lactate/albumin ratio (LAR) and C-reactive protein/albumin ratio (CAR). The performance of these indices has been evaluated in septic patients in intensive care, but until now their performance in infected patients in the Emergency Department (ED) has not been evaluated.
To investigate the potential prognostic role of albumin, LAR and CAR in patients with infection in the ED.
Single-centre prospective study performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital (Italy). All patients with infection were enrolled. The study outcome was death within 30 days. The predictive ability of albumin, LAR and CAR was assessed by area under the receiver operating characteristic curves (AUROCs). A multivariate logistic regression model was used to examine the association of the indices with 30-day mortality, with comorbidity, acute urgency and severity of infection as covariates.
The study enrolled 962 patients with an infectious status. The overall 30-day mortality rate was 8.9% (86/962). The AUROC of albumin was 0.831 (95% CI 0.795-868), while for LAR this was 0.773 (CI95% 0.719-0.827) and for CAR 0.718 (CI95% 0.664-0.771). The odds ratio for 30-day mortality for albumin was 3.362 (95% CI 1.904-5.936), for ln(LAR) 2.651 (95% CI 1.646-4.270) and for ln(CAR) 1.739 (95% CI 1.326-2.281).
All three indices had a good discriminatory ability for the risk of short-term death in patients with infection, indicating their promising use in the ED as well as in the ICU. Further studies are needed to confirm the better performance of albumin compared to LAR and CAR.
To investigate the potential prognostic role of albumin, LAR and CAR in patients with infection in the ED.
Single-centre prospective study performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital (Italy). All patients with infection were enrolled. The study outcome was death within 30 days. The predictive ability of albumin, LAR and CAR was assessed by area under the receiver operating characteristic curves (AUROCs). A multivariate logistic regression model was used to examine the association of the indices with 30-day mortality, with comorbidity, acute urgency and severity of infection as covariates.
The study enrolled 962 patients with an infectious status. The overall 30-day mortality rate was 8.9% (86/962). The AUROC of albumin was 0.831 (95% CI 0.795-868), while for LAR this was 0.773 (CI95% 0.719-0.827) and for CAR 0.718 (CI95% 0.664-0.771). The odds ratio for 30-day mortality for albumin was 3.362 (95% CI 1.904-5.936), for ln(LAR) 2.651 (95% CI 1.646-4.270) and for ln(CAR) 1.739 (95% CI 1.326-2.281).
All three indices had a good discriminatory ability for the risk of short-term death in patients with infection, indicating their promising use in the ED as well as in the ICU. Further studies are needed to confirm the better performance of albumin compared to LAR and CAR.
摘要：
背景：最近通过一些预测指标（如白蛋白浓度）丰富了脓毒症患者的预后评估，乳酸/白蛋白比（LAR）和C反应蛋白/白蛋白比（CAR）。这些指标的表现已在重症监护的败血症患者中进行了评估，但是到目前为止，他们在急诊科（ED）感染患者中的表现尚未得到评估。
目的：为了研究白蛋白的潜在预后作用，ED中感染患者的LAR和CAR。
方法：单中心前瞻性研究于2021年1月1日至2021年12月31日在意大利梅拉诺医院的ED进行。所有感染患者均入选。研究结果是30天内死亡。白蛋白的预测能力，通过接受者工作特征曲线下面积(AUROC)评估LAR和CAR。使用多变量逻辑回归模型来检查指标与30天死亡率的关联。合并症，急性急迫性和感染的严重程度为协变量。
结果：该研究招募了962名感染状态的患者。总体30天死亡率为8.9%(86/962)。白蛋白的AUROC为0.831（95％CI0.795-868），而LAR为0.773（CI95%0.719-0.827），CAR为0.718（CI95%0.664-0.771）。白蛋白30天死亡率的比值比为3.362（95％CI1.904-5.936），ln（LAR）2.651（95%CI1.646-4.270）和ln（CAR）1.739（95%CI1.326-2.281）。
结论：这三个指标对感染患者短期死亡的风险都有很好的辨别能力，表明它们有希望在ED和ICU中使用。需要进一步的研究来证实白蛋白与LAR和CAR相比具有更好的性能。
目的：为了研究白蛋白的潜在预后作用，ED中感染患者的LAR和CAR。
方法：单中心前瞻性研究于2021年1月1日至2021年12月31日在意大利梅拉诺医院的ED进行。所有感染患者均入选。研究结果是30天内死亡。白蛋白的预测能力，通过接受者工作特征曲线下面积(AUROC)评估LAR和CAR。使用多变量逻辑回归模型来检查指标与30天死亡率的关联。合并症，急性急迫性和感染的严重程度为协变量。
结果：该研究招募了962名感染状态的患者。总体30天死亡率为8.9%(86/962)。白蛋白的AUROC为0.831（95％CI0.795-868），而LAR为0.773（CI95%0.719-0.827），CAR为0.718（CI95%0.664-0.771）。白蛋白30天死亡率的比值比为3.362（95％CI1.904-5.936），ln（LAR）2.651（95%CI1.646-4.270）和ln（CAR）1.739（95%CI1.326-2.281）。
结论：这三个指标对感染患者短期死亡的风险都有很好的辨别能力，表明它们有希望在ED和ICU中使用。需要进一步的研究来证实白蛋白与LAR和CAR相比具有更好的性能。
