Lactate-Albumin Ratio as a Prognostic Predictor Value in Patients Mortality with Postoperative Sepsis

Abstract

Background: Sepsis remains a leading cause of mortality following surgical procedures despite advancements in perioperative care. This study aims to evaluate the prognostic value of the lactate-albumin ratio (LAR) for predicting 30-day mortality in patients with postoperative sepsis.

Methods: This prospective observational study included 100 consecutive adult patients who developed sepsis within 72 hours following surgery. Serum lactate and albumin levels were measured at sepsis diagnosis, and the lactate-albumin ratio was calculated. The primary outcome was 30-day all-cause mortality. The discriminatory ability of LAR was assessed using receiver operating characteristic (ROC) curve analysis and compared with lactate alone, albumin alone, Sequential Organ Failure Assessment (SOFA) score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score.

Results: The 30-day mortality rate was 32%. Non-survivors had significantly higher lactate levels (5.8 ± 2.3 vs. 2.6 ± 1.1 mmol/L, p < 0.001), lower albumin levels (2.1 ± 0.4 vs. 2.8 ± 0.5 g/dL, p < 0.001), and higher LAR (2.76 ± 0.97 vs. 0.93 ± 0.35, p < 0.001) compared to survivors. LAR demonstrated excellent discriminatory ability for predicting mortality (AUC 0.912, 95% CI: 0.856-0.968), outperforming lactate alone (AUC 0.877), albumin alone (AUC 0.829), SOFA score (AUC 0.843), and APACHE II score (AUC 0.825). The optimal LAR cutoff value of 1.45 yielded 90.6% sensitivity and 83.8% specificity. In multivariate analysis, LAR >1.45 (OR 5.87, 95% CI: 2.68-12.89, p < 0.001), age ≥65 years (OR 2.54, p = 0.018), emergency surgery (OR 2.31, p = 0.035), and SOFA score (OR 1.24, p = 0.002) were independent predictors of mortality. Patients with LAR >1.45 had significantly longer ICU stays, increased mechanical ventilation duration, and higher rates of organ dysfunction.

Conclusion: The lactate-albumin ratio is a simple, readily available biomarker with excellent prognostic accuracy for predicting mortality in patients with postoperative sepsis. LAR outperforms both its individual components and conventional scoring systems, making it a valuable tool for early risk stratification in this vulnerable patient population.