Correlation between Lactate Dehydrogenase to Albumin Ratio and the Prognosis of Patients with Cardiac Arrest

Abstract

Background: Cardiac arrest (CA) is a common event in the intensive care unit (ICU), which seriously threatens the prognosis of patients. Therefore, it is crucial to determine a simple and effective clinical indicator to judge the prognosis of patients after a CA for later treatments. The purpose of this study was to investigate the relationship between the lactate dehydrogenase to albumin ratio (LAR) and the prognosis of patients after a CA.

Methods: The clinical data of participants was obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV, v2.0; 2008 to 2019). According to the 30-day prognosis, patients were divided into a survivors group (n = 216) and a non-survivors group (n = 304). The optimal LAR threshold was determined using restricted cubic spline (RCS), which divided patients into a high LAR group ( $\ge$ 15.50, n = 257) and a low LAR group ( $<$ 15.50, n = 263). The ICU hospitalization and 30-day accumulative survival curves of the two groups were plotted following the Kaplan-Meier survival analysis. Multivariate Cox regression was used to analyze the relationship between the LAR and the prognosis of CA patients. Receiver operating characteristic (ROC) curves were drawn to evaluate the predictive efficacy of the LAR on 30-day all-cause mortality, and sensitivity analysis was used to check the reliability of the findings.

Results: A total of 520 patients with CA were enrolled and the 30-day mortality was 58.46%. The LAR in the non-survivors group was higher than in the survivors group. The RCS showed a linear trend relationship between the LAR and the mortality risk in patients during their ICU stay and 30 days; moreover, as the LAR increased, so did the risk of mortality. The Kaplan-Meier survival curve showed that compared with the low LAR group, the cumulative survival rates of ICU hospitalization and 30 days were lower in the high LAR group among CA patients (p $<$ 0.001). Multivariate Cox regression analysis showed that an elevated LAR ( $\ge$ 15.50) was an independent risk factor for mortality during ICU stay and 30 days (p $<$ 0.005). ROC analysis suggested that the LAR was superior to the sequential organ failure assessment (SOFA) score in predicting the 30-day all-cause mortality in CA patients (area under the curve (AUC) = 0.676, 95% confidence interval [CI]: 0.629-0.723). To verify the reliability of our findings, we performed sensitivity analyses and found that the findings were reliable.

Conclusions: An elevated LAR might be a predictor of mortality in patients following a CA during ICU hospitalization and 30 days, thereby it can be used to provide a reference for the clinical management of these patients.

Keywords: MIMIC-IV; cardiac arrest; clinical research; lactate dehydrogenase to albumin ratio; prognosis.

Fig. 1.

Enrollment of research patients. ICU, intensive care unit; MIMIC-IV, Medical Information Mart for Intensive Care IV.

Fig. 2.

Correlation between LAR and mortality risk in CA patients during ICU stay (a) and 30 days (b). RCS adjusted for SOFA score, lactic acid, HB, RDW, ALT, AST, TBI, BUN, CRE, PT, anion gap, norepinephrine, liver cirrhosis, VF, IABP, and echocardiography. LAR, lactate dehydrogenase to albumin ratio; CA, cardiac arrest; ICU, intensive care unit; RCS, restricted cubic spline; HR, hazard ratio; 95% CI, 95% confidence interval; SOFA, sequential organ failure assessment; HB, hemoglobin; RDW, red cell distribution width; ALT, alanine transaminase; AST, aspartate aminotransferase; TBI, total bilirubin; BUN, blood urea nitrogen; CRE, creatinine; PT, prothrombin time; VF, ventricular fibrillation; IABP, intra-aortic balloon pump.

Fig. 3.

K-M curve of patients after CA during ICU hospitalization (a) and 30 days (b). LAR, lactate dehydrogenase to albumin ratio; K–M, Kaplan–Meier; CA, cardiac arrest; ICU, intensive care unit.

Fig. 4.

ROC analysis of the predictive efficacy of LAR on 30-day all-cause mortality in patients with CA. LAR, lactate dehydrogenase to albumin ratio; SOFA, sequential organ failure assessment; ROC, receiver operating characteristic curve; CA, cardiac arrest.