GIÁ TRỊ TỈ LỆ LACTAT/ALBUMIN VÀ LACTAT/ALBUMIN X ĐIỂM TUỔI TRONG TIÊN LƯỢNG TỬ VONG Ở BỆNH NHÂN SỐC NHIỄM TRÙNG SAU PHẪU THUẬT

Abstract

Objective: Evaluation of the relationship and prognostic value of 28-day mortality of Lactate/Albumin ratio and Lactate/Albumin x age score with SOFA and APACHE II scores in patients with postoperative septic shock. Subjects and methods: Cross-sectional study of 117 patients with postoperative septic shock, aged >18 years, diagnosed according to Sepsis 3-2016 criteria and treated at the Center for Anesthesia and Surgical Resuscitation, Vietduc University Hospital, enrolled from June 2024 to April 2025. General patient data including gender, age, ASA index, laboratory index, SOFA and APACHE II sequential organ failure assessment scores were recorded. Patients were classified into survival or death groups to assess their prognosis. Results: The study analyzed 117 patients and found that the lactate/albumin ratio was similar between sexes, infection site, ASA, and age group with no statistically significant difference. Lactate/albumin and lactate/albumin x age points have homologous correlation with lactate, SOFA, APACHE II and inverse with albumin. Multivariate logistic regression analysis was used to compare variables in the survival and death groups, which showed that Age score ≥ 3, Lactate score ≥ 2.95, SOFA score ≥ 9 points, Lactate/Albumin ratio ≥ 0.16, and APACHE II score ≥ 19 points were independent risk factors for 28-day mortality in postoperative septic shock patients. The predictive values ​​of lactate/albumin ratio, SOFA and APACHE II were similar and there was no significant difference between groups (Lactate/albumin: AUC = 0.85 95% CI 0.78-0.93 with SOFA: AUC = 0.85 95% CI 0.80-0.93 with APACHE II: AUC= 0.86 95% CI 0.81-0.93) with the cutoff value of lactate/albumin ratio = 0.16 with a sensitivity of 91% and a specificity of 78%. The value of the Lactate/albumin ratio x age score had the highest predictive value for 28-day mortality in postoperative septic shock patients (AUC = 0.88 95% CI 0.78-0.95) with a cutoff value = 0.48.  Lactate also had a good predictive value for mortality (AUC = 0.75 95% CI 0.65-0.87) while the Albumin value had no predictive value (AUC =0.28 95%CI 0.18-0.37). Conclusion: Lactate/albumin index is an independent mortality risk factor with a predictive value of 28-day mortality in septic shock after surgery, with a prognostic value equivalent to SOFA and APACHE II indexes. Lactate/albumin index x age score has an even better prognostic value in predicting 28-day mortality in patients with septic shock after surgical surgery.