Abstract：
Accurately estimating the prognosis of septic patients on arrival in the emergency department (ED) is clinically challenging. The lactate-to-albumin ratio (LAR) has recently been proposed to improve the predictive performance of septic patients admitted to the ICU.
This study aims to assess whether the LAR could be used as an early prognostic marker of 30-day mortality in patients with sepsis in the ED.
A prospective observational study was conducted in the ED of the Hospital of Merano. All patients with a diagnosis of sepsis were considered. The LAR was recorded on arrival in the ED. The primary outcome measure was mortality at 30 days. The predictive role of the LAR for mortality was evaluated with the area under the ROC curve, logistic regression adjusted for the Charlson Comorbidity Index value, National Early Warning Score, and Sequential Organ Failure score, and with decision tree analysis.
459 patients were enrolled, of whom 17% (78/459) died at 30 days. The median LAR of the patients who died at 30 days (0.78 [0.45-1.19]) was significantly higher than the median LAR of survivors (0.42 [0.27-0.65]) (p < 0.001). The discriminatory ability of the LAR for death at 30 days was 0.738, higher than that of lactate alone (0.692), and slightly lower than that of albumin alone (0.753). The decision trees confirmed the role of the LAR as an independent risk factor for mortality.
The LAR can be used as an index to better predict the 30-day risk of death in septic patients.
This study aims to assess whether the LAR could be used as an early prognostic marker of 30-day mortality in patients with sepsis in the ED.
A prospective observational study was conducted in the ED of the Hospital of Merano. All patients with a diagnosis of sepsis were considered. The LAR was recorded on arrival in the ED. The primary outcome measure was mortality at 30 days. The predictive role of the LAR for mortality was evaluated with the area under the ROC curve, logistic regression adjusted for the Charlson Comorbidity Index value, National Early Warning Score, and Sequential Organ Failure score, and with decision tree analysis.
459 patients were enrolled, of whom 17% (78/459) died at 30 days. The median LAR of the patients who died at 30 days (0.78 [0.45-1.19]) was significantly higher than the median LAR of survivors (0.42 [0.27-0.65]) (p < 0.001). The discriminatory ability of the LAR for death at 30 days was 0.738, higher than that of lactate alone (0.692), and slightly lower than that of albumin alone (0.753). The decision trees confirmed the role of the LAR as an independent risk factor for mortality.
The LAR can be used as an index to better predict the 30-day risk of death in septic patients.
摘要：
■在到达急诊科（ED）时准确估计败血症患者的预后在临床上具有挑战性。最近提出了乳酸与白蛋白之比（LAR）来改善入住ICU的败血症患者的预测性能。
■本研究旨在评估LAR是否可用作ED中脓毒症患者30天死亡率的早期预后指标。
■在梅拉诺医院的急诊室进行了一项前瞻性观察性研究。考虑所有诊断为败血症的患者。LAR在到达ED时被记录。主要结果指标是30天的死亡率。用ROC曲线下面积评估LAR对死亡率的预测作用，根据Charlson合并症指数值调整的逻辑回归，国家预警评分,和序贯器官衰竭评分，并进行了决策树分析。
■459名患者入组，其中17％（78/459）在30天死亡。30天死亡患者的LAR中位数（0.78[0.45-1.19]）明显高于幸存者的LAR中位数（0.42[0.27-0.65]）（p<0.001）。LAR对30天死亡的辨别能力为0.738，高于单独的乳酸(0.692)，略低于单独的白蛋白（0.753）。决策树证实了LAR作为死亡的独立危险因素的作用。
■LAR可以作为更好地预测败血症患者30天死亡风险的指标。
■本研究旨在评估LAR是否可用作ED中脓毒症患者30天死亡率的早期预后指标。
■在梅拉诺医院的急诊室进行了一项前瞻性观察性研究。考虑所有诊断为败血症的患者。LAR在到达ED时被记录。主要结果指标是30天的死亡率。用ROC曲线下面积评估LAR对死亡率的预测作用，根据Charlson合并症指数值调整的逻辑回归，国家预警评分,和序贯器官衰竭评分，并进行了决策树分析。
■459名患者入组，其中17％（78/459）在30天死亡。30天死亡患者的LAR中位数（0.78[0.45-1.19]）明显高于幸存者的LAR中位数（0.42[0.27-0.65]）（p<0.001）。LAR对30天死亡的辨别能力为0.738，高于单独的乳酸(0.692)，略低于单独的白蛋白（0.753）。决策树证实了LAR作为死亡的独立危险因素的作用。
■LAR可以作为更好地预测败血症患者30天死亡风险的指标。
