Utility of the Lactate/Albumin Ratio as a Predictor for Mortality in Necrotizing Fasciitis Patients

Kiew-Kii Lau; Cheng-Ting Hsiao; Wen-Chih Fann; Chia-Peng Chang

doi:10.1155/2021/3530298

Utility of the Lactate/Albumin Ratio as a Predictor for Mortality in Necrotizing Fasciitis Patients

Emerg Med Int. 2021 Oct 13:2021:3530298. doi: 10.1155/2021/3530298. eCollection 2021.

Authors

Kiew-Kii Lau¹, Cheng-Ting Hsiao^{1

2}, Wen-Chih Fann¹, Chia-Peng Chang¹

Affiliations

¹ Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.
² Department of Medicine, Chang Gung University, Taoyuan, Taiwan.

Abstract

Background: The lactate/albumin (L/A) ratio has been proposed as a prognostic marker because the ratio is associated with multiple organ failure and mortality in critically ill patients. We aimed to investigate the clinical utility of the L/A ratio as a good prognostic indicator of mortality in a cohort of necrotizing fasciitis patients.

Method: This retrospective study was conducted in two tertiary hospitals in Taiwan between 2015 and 2020. We reviewed adult patients with measured serum lactate and albumin on the emergency department (ED) arrival to evaluate the prognostic performance of the lactate and lactate/albumin (L/A) ratio for outcome prediction.

Result: Of the 262 NF patients, 20 (7.63%) died in the hospital. The area under the receiver operating characteristic curve (AUROC) value of the L/A ratio (0.76, 95% confidence interval [CI] 0.69-0.81, P < 0.01) was higher than lactate alone (0.71, 95% CI 0.65-0.74 P < 0.01) for predicting in-hospital mortality. The optimal cutoff of the L/A ratio was 1.61. The AUROC value of the L/A ratio was better than lactate alone regardless of normal lactate level. The cutoff of L/A ratio and hypoalbuminemia showed further discriminative value for in-hospital mortality even in patients with normal lactate levels.

Conclusion: The prognostic performance of the L/A ratio was superior to a single measurement of lactate for predicting in-hospital mortality and intensive care unit (ICU) lengths in necrotizing fasciitis patients. Aggressive intervention and intensive care were necessary for high-risk NF patients upon ED arrival.