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J Korean Soc Emerg Med > Volume 30(1); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(1): 22-32.
응급실로 내원한 패혈성 쇼크 환자에서의 급성 신 손상 발생의 예측 인자로서 젖산/알부민 비율의 유용성
이정우1, 유제성1, 정성필1 , 좌민홍1 , 공태영1,2 , 고동률1 , 황윤정1, 이용희1, 박인철1, 김시내3
1연세대학교 의과대학 응급의학교실
2강원대학교 대학원 의학과 응급의학교실
3연세대학교 의과대학 연구부 통계지원실
Lactate/albumin ratio for the prediction of the development of sepsis-induced acute kidney injury in the emergency department
Jeong Woo Lee1, Je Sung You1, Sung Phil Chung1 , Minhong Choa1 , Taeyoung Kong1,2 , Dong Ryul Ko1 , Yoon Jung Hwang1, Yong Hee Lee1, Incheol Park1, Sinae Kim3
1Department of Emergency Medicine, Yonsei University College of Medicine, Seoul
2Department of Emergency Medicine, Graduate School of Medicine, Kangwon National University, Chuncheon
3Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Taeyoung Kong ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: grampian@yuhs.ac,
Received: July 20, 2018; Revised: October 15, 2018   Accepted: October 16, 2018.  Published online: February 28, 2019.
The early prediction of acute kidney injury (AKI) in sepsis and the provision of prompt treatment may improve the outcomes. This study investigated the efficacy of the lactate/albumin ratio (LAR) in predicting severe AKI in cases of septic shock.
This retrospective, observational cohort study was performed on patients integrated prospectively in a critical pathway of early-goal-directed therapy (EGDT)/SEPSIS. Adult patients with septic shock, who were admitted to the emergency department with a normal kidney function or stage 1 disease based on the Acute Kidney Injury Network classification between January 1, 2014 and September 30, 2017, were analyzed. The outcomes were the development of sepsis-induced severe AKI within 7 days.
A total of 343 patients were enrolled. An increase in the LAR value at admission (odds ratio [OR], 1.85; P=0.001) was a strong independent predictor of the development of severe AKI. The increasing predictability of AKI was closely associated with a L/A ratio≥0.794 at admission (OR, 14.66; P<0.001). The area under the receiver operating characteristic curve value of the L/A ratio (0.821; 95% confidence interval [CI], 0.774-0.861; P<0.01) was higher than that of lactate (0.795; 95% CI, 0.747-0.838; P<0.01) for predicting severe AKI (P=0.032).
L/A ratio was found to be an independent predictor of the development of severe AKI in septic shock. The prognostic performance of the L/A ratio for predicting AKI of critically ill sepsis patients was superior to that of lactate measurements.
Key words: Sepsis; Acute kidney injury; Lactic acid; Albumins; Prognosis
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