Lactate Dehydrogenase to Albumin ratio as a Predictive Factor of COVID-19 Patients’ Outcome; a Cross-sectional Study
Archives of Academic Emergency Medicine,
Vol. 10 No. 1 (2022),
1 January 2022
,
Page e63
https://doi.org/10.22037/aaem.v10i1.1646
Abstract
Introduction: Despite the increasing vaccination coverage, COVID-19 is still a concern. With the limited health care capacity, early risk stratification is crucial to identify patients who should be prioritized for optimal management. The present study investigates whether on-admission lactate dehydrogenase to albumin ratio (LAR) can be used to predict COVID-19 outcomes.
Methods: This retrospective cross-sectional study evaluated hospitalized COVID-19 patients in an academic referral center in Iran from May 2020 to October 2020. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of LAR in the prediction of mortality. The Yuden index was used to find the optimal cut-off of LAR to distinguish severity. Patients were classified into three groups (LAR tertiles), first: LAR<101.46, second: 101.46≤LAR< 148.78, and third group: LAR≥148.78. Logistic regression analysis was used to identify the association between tertiles of LAR, as well as the relationship between each one-unit increase in LAR with mortality and ICU admission in three models, based on potential confounding variables
Results: A total of 477 patients were included. Among all patients, 100 patients (21%) died, and 121 patients (25.4%) were admitted to intensive care unit (ICU). In the third group, the risk of mortality and ICU admission increased 7.78 times (OR=7.78, CI: 3.95-15.26; p <0.0001) and 4.49 times (OR=4.49, CI: 2.01-9.04; p <0.0001), respectively, compared to the first group. The AUC of LAR for prediction of mortality was 0.768 (95% CI 0.69- 0.81). LAR ≥ 136, with the sensitivity and specificity of 72% (95%CI: 62.1-80.5) and 70% (95%CI: 64.9-74.4), respectively, was the optimal cut-off value for predicting mortality.
Conclusion: High LAR was associated with higher odds of COVID-19 mortality, ICU admission, and length of hospitalization. On-admission LAR levels might help health care workers identify critical patients early on.
- Serum Albumin
- L-Lactate Dehydrogenase
- COVID-19
- Prognosis
- Emergency Service, Hospital
How to Cite
References
Coronavirus W. Dashboard| WHO Coronavirus (COVID-19) Dashboard with vaccination data. 2021.
Team E. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)—China, 2020. China CDC Wkly. 2020;2(8):113.
Pan F, Ye T, Sun P, Gui S, Liang B, Li L, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology. 2020;295(3):715-21.
Uyeki TM, Bundesmann M, Alhazzani W. Clinical management of critically ill adults with coronavirus disease 2019 (COVID-19). 2020.
Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, evaluation, and treatment of coronavirus (COVID-19). Statpearls [internet]. 2022. available from: https://www.ncbi.nlm.nih.gov/books/NBK554776
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.
Weiss P, Murdoch DR. Clinical course and mortality risk of severe COVID-19. Lancet. 2020;395(10229):1014-5.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. jama. 2020;323(13):1239-42.
Parcha V, Kalra R, Bhatt SP, Berra L, Arora G, Arora P. Trends and Geographic Variation in Acute Respiratory Failure and ARDS Mortality in the United States. Chest. 2021;159(4):1460-72.
Rabello Filho R, Rocha LL, Corrêa TD, Pessoa CMS, Colombo G, Assuncao MSC. Blood lactate levels cutoff and mortality prediction in sepsis—time for a reappraisal? A retrospective cohort study. Shock (Augusta, Ga). 2016;46(5):480.
Mouncey PR, Osborn TM, Power GS, Harrison DA, Sadique MZ, Grieve RD, et al. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301-11.
Ullah W, Basyal B, Tariq S, Almas T, Saeed R, Roomi S, et al. Lymphocyte-to-C-reactive protein ratio: a novel predictor of adverse outcomes in COVID-19. J Clin Med Res. 2020;12(7):415.
Qu R, Ling Y, Zhang Yhz, Wei Ly, Chen X, Li Xm, et al. Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. J Med Virol. 2020;92(9):1533-41.
Chen C-Y, Lee C-H, Liu C-Y, Wang J-H, Wang L-M, Perng R-P. Clinical features and outcomes of severe acute respiratory syndrome and predictive factors for acute respiratory distress syndrome. J Chin Med Assoc. 2005;68(1):4-10.
Alizadeh N, Tabatabaei FS, Borran M, Dianatkhah M, Azimi A, Forghani SN, et al. Evaluation of the Possible Effect of the Influenza Vaccine on the Severity, Mortality, and Length of Hospitalization among Unvaccinated COVID-19 Patients; An Observational, Cross-Sectional Study. J Pharm Care. 2022;10(1):11-6.
Shin J, Hwang SY, Jo IJ, Kim WY, Ryoo SM, Kang GH, et al. Prognostic value of the lactate/albumin ratio for predicting 28-day mortality in critically ill sepsis patients. Shock. 2018;50(5):545-50.
Yin M, Si L, Qin W, Li C, Zhang J, Yang H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018;33(12):687-94.
Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis. 2019;38(4):743-6.
Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552.
Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-81.
Liu M, Zhang L, Zhang Y, Xu X, Ma T, Ni F, et al. Predictive value of lactate dehydrogenase to albumin ratio (LAR) in patients with coronavirus Disease 2019 (COVID-19). 2021.
Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of Covid-19. N Engl J Med. 2020 May 21;382(21):2049-2055.
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020;20(4):425-34.
Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020; 295(3):200463.
Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-8.
Hou H, Zhang B, Huang H, Luo Y, Wu S, Tang G, et al. Using IL-2R/lymphocytes for predicting the clinical progression of patients with COVID-19. Clin Exp Immunol. 2020;201(1):76-84.
Sun D-w, Zhang D, Tian R-h, Li Y, Wang Y-s, Cao J, et al. The underlying changes and predicting role of peripheral blood inflammatory cells in severe COVID-19 patients: A sentinel? Clin Chim Acta. 2020;508:122-9.
Jeon SY, Ryu S, Oh S-K, Park J-S, You Y-H, Jeong W-J, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor for patients with severe infection requiring intensive care. Medicine (Baltimore). 2021; 100(41): e27538.
Lee B-K, Ryu S, Oh S-K, Ahn H-J, Jeon S-Y, Jeong W-J, et al. Lactate dehydrogenase to albumin ratio as a prognostic factor in lower respiratory tract infection patients. Am J Emerg Med. 2022;52:54-8.
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