응급실로 내원한 패혈성 쇼크 환자에서의 급성 신 손상 발생의 예측 인자로서 젖산/알부민 비율의 유용성

Abstract

Objective: 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. Method: 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. Results: 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). Conclusion: 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.