Elevated lactate/albumin ratio as a novel predictor of in-hospital mortality in hospitalized cirrhotics

• Published in: Annals of hepatology Vol. 28; no. 3; p. 100897
• Main Authors: Krispin, Itamar, Mahamid, Mahmud, Goldin, Eran, Fteiha, Bashar
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier España, S.L.U 01.05.2023; Elsevier
• Subjects: Acute-On-Chronic Liver Failure - diagnosis; Albumins; Cirrhosis; Cohort Studies; Hepatic decompensation; Hospital Mortality; Humans; Intensive care; Lactic Acid; Liver Cirrhosis - complications; Liver failure; Mortality; Prognosis; Retrospective Studies; ROC Curve; ALK; NO; Intensive care; NAFLD; AST; Mortality; HVPG; ALT; INR; Cirrhosis; Liver failure; MELD; GGT; Hepatic decompensation; WBC; Hb; BUN
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2023.100897

Novel predictors of prognosis in cirrhotic patients have been emerging in recent years and studies show that the lactate/albumin ratio can serve as an early prognostic marker in different patient groups. We aimed to uncover the clinical significance of the lactate/albumin ratio in hospitalized patients with acutely decompensated cirrhosis. A retrospective single-center cohort study was conducted in a tertiary medical center. Subjects included had an established diagnosis of liver cirrhosis and were admitted to the ICU or the Internal Medicine department with a clinical picture of acute-on-chronic liver failure between the years 2010 and 2021. The primary outcome was to assess the utility of the lactate/albumin ratio as a prognostic marker to predict mortality in hospitalized cirrhotic patients with acute-on-chronic hepatic failure. Two hundred seventy-nine patients were included in this study. Univariate analysis revealed that mean WBC count, platelet/creatinine ratio, aspartate transaminase (AST), lactate, and MELD score were all significantly associated with the primary outcome. Multivariate analysis showed that the lactate/albumin ratio was the strongest statistically significant (p < 0.001) predictor of death during hospitalization - OR 13.196 (95% CI 3.6–48.3), followed by mean WBC count, MELD score, and serum lactate levels. A ROC curve was constructed, which resulted in an area under the curve (AUC) equal to 0.77. Crosstabs from the ROC showed a sensitivity of 66.7% and a specificity of 76.2% when the lactate/albumin ratio chosen as a cutoff was 0.9061 Elevated lactate/albumin ratio predicts in-hospital mortality in hospitalized cirrhotics with acute-on-chronic hepatic failure.