The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio

Kai Yang Lim; Wan Fadzlina Wan Muhd Shukeri; Wan Mohd Nazaruddin Wan Hassan; Mohd Basri Mat-Nor; Muhammad Hafiz Hanafi

doi:10.5005/jp-journals-10071-24324

The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio

Indian J Crit Care Med. 2022 Oct;26(10):1126-1130. doi: 10.5005/jp-journals-10071-24324.

Authors

Kai Yang Lim¹, Wan Fadzlina Wan Muhd Shukeri¹, Wan Mohd Nazaruddin Wan Hassan¹, Mohd Basri Mat-Nor², Muhammad Hafiz Hanafi³

Affiliations

¹ Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
² Department of Anaesthesiology and Intensive Care, School of Medical Sciences, International Islamic University Malaysia, Kuantan, Pahang, Malaysia.
³ Department of Rehabilitation Medicine Unit and Department of Neurosciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia.

Abstract

Background: The association between interleukin-6 (IL-6) and serum albumin (ALB) with mortality in critically ill elderly patients, either as stand-alone biomarkers or in combination, has been scarcely reported. We, therefore, aimed to investigate the prognostic value of the IL-6-to-albumin ratio in this special population.

Patients and methods: This was a cross-sectional study conducted in the mixed intensive care unit (ICU) of two university-affiliated hospitals in Malaysia. Consecutive elderly patients (aged above or equal to 60 years) admitted to the ICU, who underwent simultaneous measurement of plasma IL-6 and serum ALB, were recruited. The prognostic value of the IL-6-to-albumin ratio was assessed by analysis of the receiver-operating characteristic (ROC) curve.

Results: A total of 112 critically ill elderly patients were recruited. The outcome of all-cause ICU mortality was 22.3%. The calculated IL-6-to-albumin ratio was significantly higher in the non-survivors compared to the survivors {14.1 [interquartile range (IQR), 6.5-26.7] vs 2.5 [(IQR, 0.6-9.2) pg/mL, p <0.001]}. The area under the curve (AUC) of IL-6-to-albumin ratio for discrimination of ICU mortality was 0.766 [95% confidence interval (CI), 0.667-0.865, p <0.001] which was slightly higher than that of IL-6 and albumin alone. The ideal cut-off value of the IL-6-to-albumin ratio was above 5.7 with a sensitivity of 80.0% and specificity of 64.4%. After adjusting for severity of illness, the IL-6-to-albumin ratio remained as an independent predictor of ICU mortality with an adjusted odd ratio of 0.975 (95% CI, 0.952-0.999, p = 0.039).

Conclusion: The IL-6-to-albumin ratio offers a slight improvement in mortality prediction than either of its constituent individual biomarkers and as such, it may be a potential tool to aid in the prognostication of critically ill elderly patients although this requires further validation in a larger prospective study.

How to cite this article: Lim KY, Shukeri WFWM, Hassan WMNW, Mat-Nor MB, Hanafi MH. The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio. Indian J Crit Care Med 2022;26(10):1126-1130.

Keywords: Albumin; Elderly; Intensive care unit; Intensive care unit mortality; Interleukin-6.