الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Sepsis remains a substantial source of mortality and health care costs worldwide. In the US, the incidence of sepsis has steadily risen at a rate of 13% annually over the past decade and is estimated to carry a significant burden of healthcare in the future. Sepsis-related mortality is reported to be as high as 29.9%. Worldwide, the incidence and mortality associated with sepsis continues to climb.
Time is of the essence in the treatment of sepsis; early and aggressive treatment is important to reduce mortality. In 30–50% of patients, sepsis treatment is initiated in the emergency department (ED). Considering that ICU capacity is limited and that not all sepsis patients will benefit from ICU admission, the main challenge that ED physicians face is to effectively stratify patients into patients requiring ICU treatment and patients who can be treated at ward. Incorrect stratification may result in increased morbidity and mortality, and increased length of stay.
The lactate/albumin ratio (LAR) has potential benefits for prognostication of sepsis patients. The two markers independently predict mortality, and the values inversely change by different mechanisms. Thus, a combination of the 2 parameters might increase the predictive value. Also, normal or intermediate levels of lactate might be misinterpreted as a good prognosis. The LAR ratio might help identification of high-risk patients.
The aim of this study was to evaluate the prognostic performance of the lactate/albumin (L/A) ratio when combined with APACH II score, SOFA score and SAPS II for predicting 28-day mortality in critically ill patients with septic shock
In this prospective observational study, after approval of the Medical Ethics Committee of Ain Shams Faculty of Medicine, 100 adult patients of both sexes with septic shock were enrolled. Different stratification scores were evaluated directly upon admission besides measuring their LAR. Then, they were categorized into 2 groups according to their 28-days mortality. 64% of them were died (non-survivors group) and 36% were survived (survivors group).
In this study, the mean of LAR of all patients was 1.67. Non-survivors were presented with significantly higher mean of LAR values (3.08) than survivors (1.52) (p ˂ 0.001). LAR ≥ 1.08 was a good tool to predict 28-days mortality (AUC=0.883, 95% CI: 0.745-0.900, p<0.0001).
The prognostic performance of Lactate/Albumin ratio combined with APACHI II, SOFA and SAPS scores was superior to that of a single score for predicting 28-days mortality of critically ill patients with septic shock.
In the light of the current study, we conclude that; after correction for several relevant confounders in a multivariate analysis, Lactate/Albumin ratio combined with APACHI II, SOFA and SAPS scores gave the best predictive value for mortality in septic shock patients, when compared with each separate score.
However, further prospective multi-centers search, with large sample size, is recommended to confirm this conclusion. Till that, clinicians can provide an objective prediction-based assessment of combined scores for patient’s outcomes and to guide decision-making in a wisdom way.