Prioritized factors of severity prognosis in patients admitted for sepsis or septic shock in a resource-limited region of central Vietnam

Abstract

Objectives: The early diagnosis and prognostication of severity in sepsis plays a crucial role in determining appropriate treatment strategies. This study aimed to assess the role of cheaper prognostic factors including lactate/albumin ratio and platelet count in patients with sepsis as they are correlated with the rate of multiorgan failure, and mortality rate.

Methods: A cross-sectional study was conducted on 146 adult patients diagnosed with sepsis and septic shock according to the Sepsis-3 definition. All patients were admitted at either the intensive care unit of Hue University of Medicine and Pharmacy Hospital or Hue Central Hospital.

Results: Average age of patients was 67 years-old, with 37.7% having sepsis and 62.3% with septic shock. The overall mortality rate in the study was 51.4% (75/146 patients). Forty six patients (32.5%) had thrombocytopenia, with mild, moderate, and severe decreases accounting for 8.9%, 21.2%, and 1.4%, respectively. The lactate/albumin ratio with a cutoff of 2.1 was the best prognostic factor for mortality with an AUROC of 0.76, sensitivity of 58.7%, and specificity of 88.7% compared to other biomarkers including lactate (AUROC = 0.71), albumin (AUROC = 0.74), platelet count (AUROC = 0.65), white blood cell count (AUROC = 0.48), procalcitonin (AUROC = 0.43), and BE (AUROC = 0.44). Multivariate regression analysis identified the L/A ratio, platelet count, SOFA score as significant predictors of mortality 
in sepsis.

Conclusion: The lactate/albumin ratio with a cutoff of 2.1 is an available effective tool for severity prognosis of patients with sepsis/septic shock in developing countries.