| Objective: To evaluate the prognosis of patients with sepsis by monitoring the ratio of uric acid/serum albumin and lactic acid/serum albumin,and to explore the value of lactic acid/albumin and uric acid/albumin in 28-day mortality in patients with sepsis.Methods:A total of 116 patients with sepsis who were admitted to the Department of Critical Care Medicine of the Affiliated Hospital of Youjiang Medical College for Nationalities from October 2021 to September 2022 and met the inclusion criteria were retrospectively analyzed.The clinical efficacy was evaluated on the 28 th day.The patients were divided into group A(2-5 points),group B(6-8 points),group C(9-11 points),group D(12-14 points)and group E(> 15 points)according to the SOFA score when they were diagnosed with sepsis.According to the final outcome of 28 days,the patients were further divided into survival group and death group(in-hospital death,not prescribed within 28 days after discharge).The oxygenation index,platelet,bilirubin,lactic acid,uric acid,albumin and other examination indicators of the subjects were collected on day 0,day 1,day 2,day 3,and day 7.The data were collected and sorted out,and the SOFA scores,uric acid/albumin and lactic acid/albumin ratios were calculated on day 0,day 1,day 2,day 3 and day 7.Descriptive statistical methods were used for comparison by Excel 2010 and SPSS 22.0 software.Kaplan-Meier method was used to draw the survival curve,and log-rank test was used to analyze and screen the independent risk factors of death by multivariate Cox regression model.Results:1.There were 9 patients in group A,with an average age of(55.56 ±4.80)years,including 7 males and 2 females.There were 18 patients in group B,with an average age of(60.00 ±4.64)years,including 10 males and 8 females.There were 18 patients in group C,with an average age of(56.89 ±4.37)years,including 12 males and 6 females.There were 26 patients in group D,with an average age of(61.31 ±2.84)years,including 16 males and 10 females.Group E consisted of 45 patients,with an average age of(52.93± 3.18)years,including 34 males and 11 females.There were no significant differences in mortality rate(P=0.908),male/female ratio(P= 0.497),age(P=0.418)and ICU length of stay(P=0.130)among the three groups.It can be concluded that there were no significant differences in gender,mortality,age and length of ICU stay among the five groups.2.By A,B,C,D,E on day 0 of sepsis patients lactic acid,uric acid,albumin,lactate/albumin,uric acid/albumin were statistically analyzed.The results showed that there were significant differences in lactic acid(P < 0.001),uric acid(P=0.048),lactic acid/albumin(P=0.004)and uric acid/albumin(P=0.014)between the two groups on day 0,but no significant difference in albumin(P= 0.426).The levels of lactic acid,uric acid,lactic acid/albumin and uric acid/albumin in group E were higher than those in groups A,B,C and D.3.Among the 116 patients,there were 52 patients in the survival group and 64 patients in the death group,with a mortality rate of 55.2%.The average age of the survival group was(56.15±19.04)years,and the average age of the death group was(58.97±16.17)years.The age of the survival group was younger than that of the death group,and the difference was statistically significant(P=0.042).There was no significant difference in gender(P=0.171).4.The lactate/albumin ratio at day 0(P=0.172),day 1(P=0.191),day 2(P=0.184),day 3(P > 0.2),and day 7(P=0.192)in the survival group;the lactate/albumin ratio at day 0(P=0.195),day 1(P > 0.2)in the death group.Day 2(P=0.196),day 3(P=0.199),day 7(P=0.164),all above 0.05.The sample size of this study was more than 50.The results of Kolmogorov-Sminov test showed that the lactate/albumin ratio in the survival group and the death group at each time point obeys normal distribution.5.Repeated measures analysis of variance showed that the sphericity test of lactate/albumin ratio(P < 0.001)did not meet the spherical hypothesis.Therefore,the results of the multivariate test shall prevail.Multivariate analysis showed that the lactate/albumin ratio changed over time(P < 0.001),but it could not be considered that the lactate/albumin ratio between the survival group and the death group would change over time(P=0.348).The between-subject effect between the survival group and the death group was statistically significant(P=0.007).The ratio of lactate to albumin on day 0(P=0.002),day 1(P=0.004),day 2(P < 0.001),day 3(P < 0.001),and day 7(P=0.001)in the death group were higher than those in the survival group,and the difference was statistically significant.6.The uric acid/albumin ratio of the survival group was 0 day(P=0.163),1 day(P=0.164),2 days(P=0.192),3 days(P > 0.2),7 days(P=0.188),and the uric acid/albumin ratio of the death group was 0 day(P=0.160),1 day(P > 0.2).The second day(P=0.191),the third day(P=0.188),and the seventh day(P=0.191)were all greater than 0.05.The sample size of this study was greater than 50.7.Repeated measures analysis of variance was used for the uric acid/albumin ratio of the survival group and the death group,and the results showed that the sphericity test of uric acid/albumin ratio(P < 0.001)did not meet the spherical hypothesis,so the results of the multivariate test were used as the standard.The results of multivariate analysis showed that the uric acid/albumin ratio changed over time(P < 0.001),but it could not be considered that the uric acid/albumin ratio between the survival group and the death group would change over time(P=0.117).There was a significant difference in the subject effect between the survival group and the death group(P=0.031).The uric acid/albumin in the death group was higher than that in the survival group on day 0(P=0.028),day 1(P=0.009),day 2(P=0.033),day 3(P=0.031),and day 7(P < 0.001).8.ROC curve was used to determine the cut-off value of lactate/albumin.ROC curve analysis showed that lactate/albumin on day 0: AUC=0.560,the best cut-off value was 0.046,P=0.027;Lactate/albumin day 1: AUC=0.592,the best cut-off value was 0.051,P=0.009;Lactate/albumin day 2: AUC=0.548,cut-off value was 0.091,P=0.038;Lactate/albumin day 3:AUC=0.653,cut-off value was 0.097,P=0.000;Lactate/albumin on day 7: AUC=0.640,cut-off value was 0.129,P=0.001.It can be considered that the lactate/albumin ratio on the third day has the greatest diagnostic value for the prognosis of patients with sepsis,and the best cut-off value is 0.097.9.ROC curve analysis showed that uric acid/albumin on day 0: AUC=0.498,cut-off value was 3.263,P=0.009;Uric acid/albumin day 1: AUC=0.583,cut-off value was 6.699,P=0.001;Uric acid/albumin day 2: AUC=0.555,cut-off value was 2.480,P=0.003;Uric acid/albumin day 3: AUC=0.542,cut-off value was 4.152,P=0.004;Uric acid/albumin day 7: AUC=0.589,cut-off value was 9.065,P=0.001.It can be considered that the uric acid/albumin ratio on the7 th day has the greatest diagnostic value for sepsis patients,and the best cut-off value is9.065.10.The survival curve of 116 patients with sepsis or sepsis was drawn,and the median survival time was 17(95%CI: 16-20)days.The lactate/albumin ratio and uric acid/albumin ratio survival curves were drawn respectively,and the log-rank test was used for analysis.The results showed that the lactate/albumin ratio on day 0(P=0.002)≤ 0.046 had a median survival time of 18 days.The median survival time of lactate/albumin on day 0 > 0.046 was17 days.The median survival time of lactate/albumin ratio on day 3(P=0.01)≤0.097 was 18 days,and that of lactate/albumin ratio on day 3 > 0.097 was 16 days.The median survival time of lactate/albumin ratio on day 7(P=0.03)≤ 0.129 was 19 days,and that of lactate/albumin ratio on day 7 > 0.129 was 15 days.The difference in survival curves was statistically significant.11.The indicators of lactate/albumin on day 0,3,and 7 with statistically significant differences in the log-rank test were included in the multivariate Cox regression model,and the stepwise regression method was used for statistical analysis.The results showed that lactate/albumin on day 0 ≤ 0.046(HR: 3.469,P=0.008).Lactate/albumin on day 3 ≤0.097(HR: 148.275,P=0.011)and lactate/albumin on day 7 ≤0.129(HR: 5.298,P=0.014)were independent risk factors for death in patients with sepsis,and the difference was statistically significant.Conclusion:Lactate/albumin ratio has a certain clinical value in predicting the mortality of patients with sepsis within 28 days,and it is recommended to include it as a monitoring index,which can be used as a simple tool to evaluate the mortality of patients with sepsis for clinical reference. |
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