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J Korean Soc Emerg Med > Volume 33(1); 2022 > Article
Journal of The Korean Society of Emergency Medicine 2022;33(1): 45-60.
중증 외상 환자에서의 다발성 장기부전 발생 예측에 있어 젖산/알부민값의 유용성
한상우 , 정성필 , 좌민홍 , 유제성 , 공태영 , 박정민 , 박인철
연세대학교 의과대학 응급의학교실
The prognostic usefulness of the lactate/albumin ratio for predicting multiple organ dysfunction syndrome in severe trauma
Sangwoo Han , Sung Phil Chung , Minhong Choa , Je Sung You , Taeyoung Kong , Jungmin Park , Incheol Park
Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
Correspondence  Jungmin Park ,Tel: 02-2019-3030, Fax: 02-2019-4820, Email: GIGI2404@yuhs.ac,
Received: March 25, 2021; Revised: June 27, 2021   Accepted: June 28, 2021.  Published online: February 28, 2022.
ABSTRACT
Objective:
Early prediction of the multiple organ dysfunction syndrome (MODS) and providing early innovative treatment may improve outcomes in patients with severe trauma. Lactate and serum albumin levels, which are widely used markers predicting the severity of critically ill patients, tend to diverge during clinical deterioration. This study aimed to evaluate the clinical utility of the lactate/albumin ratio (LAR) as a predictive factor for MODS and 30-day mortality in patients with severe trauma.
Method:
This retrospective, observational cohort study was performed with patients prospectively integrated into a critical pathway for trauma. We analyzed severe trauma patients (Injury Severity Score≥16) admitted to the emergency department (ED), between January 1, 2011, and May 31, 2017. The outcomes were the development of MODS and 30-day mortality.
Results:
In total, 348 patients were enrolled, of which 18 (5.2%) died within 96 hours of ED admission, and the remaining 330 patients (94.8%) were evaluated for the development of MODS. An increase in the LAR at admission (odds ratio, 1.618; P=0.028) was an independent predictor of MODS development. The area under the receiver operating characteristic curve (0.755) and Harrell's C-index (0.783) showed that LAR could predict MODS and 30-day mortality.
Conclusion:
Initial LAR is an independent predictor of MODS development in patients with severe trauma. Our study results suggest that an elevated LAR can be a useful prognostic marker in patients with severe trauma.
Key words: Trauma; Multiple organ dysfunction syndrome; Lactic acid; Albumins; Prognosis
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