The blood lactate/serum albumin ratio might represent a good prognostic indicator of 28-day mortality in patients with acute respiratory distress syndrome: a retrospective observational study

Abstract

Background: Acute respiratory distress syndrome (ARDS) is an acute inflammatory lung injury with a high mortality rate. However, previous ARDS prognostic scoring systems or predictors have been limited by complex formulas that are relatively expensive and inconvenient to obtain. Thus, this study aimed to explore the clinical significance of the blood lactate/serum albumin ratio (LAR) in assessing the prognosis of ARDS patients and compare it with other indicators related to 28-day mortality in ARDS patients.

Methods: We conducted a single-center retrospective study involving patients who fulfilled the Berlin definition of ARDS between 2016 and 2021. Clinical data were collected from medical records within 24 hours after ARDS diagnosis. The LAR, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio (MLR) were calculated. The primary clinical outcome was 28-day mortality. The risk factors for 28-day mortality were determined using conditional logistic regression analysis. The receiver operating characteristic curve was used to evaluate the area under the curve (AUC).

Results: A total of 276 ARDS patients met the inclusion criteria and were divided into surviving and nonsurviving groups according to 28-day mortality. There were significant differences in the Acute Physiologic Assessment and Chronic Health Evaluation II scores, Sequential Organ Failure Assessment scores, MLRs, and LARs between the surviving and nonsurviving groups. The AUC for the LAR was 0.790 (P < 0.001), whereas the AUCs for the Acute Physiologic Assessment and Chronic Health Evaluation II score, Sequential Organ Failure Assessment score, neutrophil-to-lymphocyte ratio, and MLR were 0.584, 0.599, 0.524, and 0.587, respectively. After grouping according to an LAR optimal cutoff value of 0.07, 28-day mortality was significantly higher in the high-LAR group than in the low-LAR group (47.18 vs. 12.69, P < 0.001).

Conclusion: The LAR is an independent risk factor for 28-day mortality in ARDS patients and can be used to assess the severity of ARDS to a certain extent, making it superior to other commonly used indicators.

Keywords

Acute respiratory distress syndrome / Albumin / Lactate / Mortality / Predictor

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Chen J, Gao C, and Yang Ling contributed equally to this article. Chen J and Guo Q contributed to study design. Chen J, He Y, and Yang L participated in literature search. Guo S, Sun Y, and He S participated in data collection. Chen J, Guo Q, and Yang L participated in analysis of data. Chen J prepared the manuscript, and Guo Q reviewed the manuscript.

Funding

This work was supported by grants from Jiangsu Province’sKey Provincial Talents Program (ZDRCA2016046) and Key Health Talents in Gusu (GSWS2019009).

Ethical approval of studies and informed consent

The study followed the principles of the Declaration of Helsinki as revised in 2013. This study was approved, and written informed consent was waived by the Clinical Research Ethics Committee of the First Affiliated Hospital of Soochow University (Jiangsu, China; ethical number 2019050; registration date July 29, 2019) owing to the anonymous data and anonymized retrospective nature of the analysis.

Acknowledgments

The authors thank the staff in the medical information department of hospitals for their help in data management.

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