A Valuable Tool for Risk Stratification in Septic Patients Admitted to ICU

The lactate/albumin ratio has been reported to be associated with mortality in pediatric patients with sepsis. We aimed to evaluate the lactate/albumin ratio for its prognostic relevance in a larger collective of critically ill (adult) patients admitted to an intensive care unit (ICU). A total of 348 medical patients admitted to a German ICU for sepsis between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. The association of the lactate/albumin ratio (cut-off 0.15) and both in-hospital and post-discharge mortality was investigated. An optimal cut-off was calculated by means of Youden’s index. The lactate/albumin ratio was elevated in non-survivors (p < 0.001). Patients with an increased lactate/albumin ratio were of similar age, but clinically in a poorer condition and had more pronounced laboratory signs of multi-organ failure. An increased lactate/albumin ratio was associated with adverse in-hospital mortality. An optimal cut-off of 0.15 was calculated and was associated with adverse long-term outcome even after correction for APACHE2 and SAPS2. We matched 99 patients with a lactate/albumin ratio >0.15 to case-controls with a lactate/albumin ratio <0.15 corrected for APACHE2 scores: The group with a lactate/albumin ratio >0.15 evidenced adverse in-hospital outcome in a paired analysis with a difference of 27% (95%CI 10–43%; p < 0.01). Regarding long- term mortality, again, patients in the group with a lactate/albumin ratio >0.15 showed adverse outcomes (p < 0.001). An increased lactate/albumin ratio was significantly associated with an adverse outcome in critically ill patients admitted to an ICU, even after correction for confounders. The lactate/albumin ratio might constitute an independent, readily available, and important parameter for risk stratification in the critically ill. View Full- Tex

Blood Urea Nitrogen (BUN) is independently associated with mortality in critically ill patients admitted to ICU.

Blood urea nitrogen (BUN) was reported to be associated with mortality in heart failure patients. We aimed to evaluate admission BUN concentration in a heterogeneous critically ill patient collective admitted to an intensive care unit (ICU) for prognostic relevance.A total of 4176 medical patients (67±13 years) admitted to a German ICU between 2004 and 2009 were included. Follow-up of patients was performed retrospectively between May 2013 and November 2013. Association of admission BUN and both intra-hospital and long-term mortality were investigated by Cox regression. An optimal cut-off was calculated by means of the Youden-Index.Patients with higher admission BUN concentration were older, clinically sicker and had more pronounced laboratory signs of multi-organ failure including kidney failure. Admission BUN was associated with adverse long-term mortality (HR 1.013; 95%CI 1.012-1.014; p28 mg/dL to case-controls ≤ 28mg/dL corrected for APACHE2 scores: BUN above 28 mg/dL remained associated with adverse outcome in a paired analysis with the difference being 5.85% (95%CI 1.23-10.47%; p = 0.02).High BUN concentration at admission was robustly associated with adverse outcome in critically ill patients admitted to an ICU, even after correction for co-founders including renal failure. BUN might constitute an independent, easily available and important parameter for risk stratification in the critically ill

A high MELD-XI score identified sicker patients with multiple preconditions.

<p>Normally distributed data points are expressed as mean ± standard deviation.</p

A MELD-XI >12 predicted increased intra-ICU mortality regardless of primary/secondary diagnosis.

<p>A MELD-XI >12 predicted increased intra-ICU mortality regardless of primary/secondary diagnosis.</p

A high MELD-XI score identified sicker patients with multiple preconditions.

<p>Normally distributed data points are expressed as mean ± standard deviation.</p

In a Cox regression analysis MELD-XI (changes per unit in points) was associated with increased long-term mortality regardless of admission diagnosis.

<p>In a Cox regression analysis MELD-XI (changes per unit in points) was associated with increased long-term mortality regardless of admission diagnosis.</p

Patients with a MELD-XI >12 at admission showed significantly increased long-term mortality (HR 3.69, 95%CI 3.20–4.25; p<0.001).

<p>Patients with a MELD-XI >12 at admission showed significantly increased long-term mortality (HR 3.69, 95%CI 3.20–4.25; p<0.001).</p

Comparison of MELD-XI score to APACHE and SAPS2 scores: ROC—analysis was performed and AUC calculated.

<p>Comparison of MELD-XI score to APACHE and SAPS2 scores: ROC—analysis was performed and AUC calculated.</p