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Original Articles
Surgery
Biomarkers to predict mortality in patients with Fournier’s gangrene admitted to the intensive care unit after surgery in South Korea
In Sik Shin, Seong Chan Gong, Sanghyun An, Kwangmin Kim
Acute Crit Care. 2023;38(4):452-459.   Published online November 21, 2023
DOI: https://doi.org/10.4266/acc.2023.00766
  • 1,350 View
  • 40 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
The use of biomarkers to predict patient outcomes may be crucial for patients admitted to the intensive care unit (ICU) following surgery because biomarkers guide clinicians in tailoring treatment plans accordingly. Therefore, we aimed to identify potential biomarkers to predict the prognosis of patients with Fournier’s gangrene (FG) admitted to the ICU after surgery.
Methods
We enrolled patients with FG admitted to our Hospital between January 2013 and December 2022. We retrospectively analyzed patient characteristics, factors related to management, scores known to be associated with the prognosis of FG, and laboratory data.
Results
The study population included 28 survivors and 13 nonsurvivors. The initial serum lactate level taken in the emergency department; white blood cell, neutrophil, and platelet counts; delta neutrophil index and international normalized ratio; albumin, glucose, HCO3, and postoperative lactate levels; and the laboratory risk indicator for necrotizing fasciitis differed between survivors and nonsurvivors. Postoperative lactate and initial albumin levels were independent predictors of mortality in patients with FG. In the receiver operating characteristic curve analysis, the postoperative lactate level was the best indicator of mortality (area under the curve, 0.877; 95% confidence interval, 0.711–1.000). The optimal cutoff postoperative lactate level for predicting mortality was 3.0 mmol/L (sensitivity, 80.0%; specificity, 95.0%).
Conclusions
Postoperative lactate and initial albumin levels could be potential predictors of mortality in patients with FG admitted to the ICU after surgery, and the optimal cutoff postoperative lactate and initial albumin levels to predict mortality were 3.0 mmol/L and 3.05 g/dl, respectively. Large-scale multicenter prospective studies are required to confirm our results.

Citations

Citations to this article as recorded by  
  • Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review
    Pavan Shet, Ashmit Daiyan Mustafa, Karan Varshney, Lavina Rao, Sameen Sawdagar, Florence McLennan, Siraaj Ansari, Darshan Shet, Niveshan Sivathamboo, Sian Campbell
    Surgical Infections.2024; 25(4): 261.     CrossRef
CPR/Resuscitation
Association between C-reactive protein-to-albumin ratio and 6-month mortality in out-of-hospital cardiac arrest
Hui Hwan Kim, Ji Ho Lee, Dong Hun Lee, Byung Kook Lee
Acute Crit Care. 2022;37(4):601-609.   Published online August 18, 2022
DOI: https://doi.org/10.4266/acc.2022.00542
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  • 120 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary Material
Background
The inflammatory response that occurs following cardiac arrest can determine the long-term prognosis of patients who survive out-of-hospital cardiac arrest. We evaluated the correlation between C-reactive protein-to-albumin ratio (CAR) following cardiac arrest and long-term mortality. Methods: The current retrospective observational study examined patients with post-cardiac arrest syndrome (PCAS) treated with targeted temperature management at a single tertiary care hospital. We measured CAR at four time points (at admission and then 24 hours, 48 hours, and 72 hours after) following cardiac arrest. The primary outcome was the patients’ 6-month mortality. We performed multivariable and area under the receiver operating characteristic curve (AUC) analyses to investigate the relationship between CAR and 6-month mortality. Results: Among the 115 patients, 52 (44.1%) died within 6 months. In the multivariable analysis, CAR at 48 hours (odds ratio [OR], 1.130; 95% confidence interval [CI], 1.027–1.244) and 72 hours (OR, 1.241; 95% CI, 1.059–1.455) after cardiac arrest was independently associated with 6-month mortality. The AUCs of CAR at admission and 24, 48, and 72 hours after cardiac arrest for predicting 6-month mortality were 0.583 (95% CI, 0.489–0.673), 0.622 (95% CI, 0.528–0.710), 0.706 (95% CI, 0.615–0.786), and 0.762 (95% CI, 0.675–0.835), respectively. Conclusions: CAR at 72 hours after cardiac arrest was an independent predictor for long-term mortality in patients with PCAS.

Citations

Citations to this article as recorded by  
  • The association between C-reactive protein to albumin ratio and 6-month neurological outcome in patients with in-hospital cardiac arrest
    Ji Ho Lee, Dong Hun Lee, Byung Kook Lee, Seok Jin Ryu
    World Journal of Emergency Medicine.2024; 15(3): 223.     CrossRef
  • Inflammatory response after out‐of‐hospital cardiac arrest—Impact on outcome and organ failure development
    Asser M. J. Seppä, Markus B. Skrifvars, Pirkka T. Pekkarinen
    Acta Anaesthesiologica Scandinavica.2023; 67(9): 1273.     CrossRef
  • Comparison of Prognostic Performance between Procalcitonin and Procalcitonin-to-Albumin Ratio in Post Cardiac Arrest Syndrome
    Ju Hee Yoon, Woo Sung Choi, Yong Su Lim, Jae Ho Jang
    Journal of Clinical Medicine.2023; 12(14): 4568.     CrossRef
  • C-reactive protein-to-albumin ratio as a biomarker in patients with sepsis: a novel LASSO-COX based prognostic nomogram
    Xin Zhou, Shouzhi Fu, Yisi Wu, Zhenhui Guo, Wankang Dian, Huibin Sun, Youxia Liao
    Scientific Reports.2023;[Epub]     CrossRef
Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury
Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek
Acute Crit Care. 2022;37(3):462-467.   Published online August 5, 2022
DOI: https://doi.org/10.4266/acc.2022.00052
  • 2,351 View
  • 173 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDF
Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

Citations

Citations to this article as recorded by  
  • Symptoms and Functional Outcomes Among Traumatic Brain Injury Patients 3- to 12-Months Post-Injury
    Kathryn S. Gerber, Gemayaret Alvarez, Arsham Alamian, Victoria Behar-Zusman, Charles A. Downs
    Journal of Trauma Nursing.2024; 31(2): 72.     CrossRef
Liver
The role of bilirubin to albumin ratio as a predictor for mortality in critically ill patients without existing liver or biliary tract disease
Ji Soo Choi, Kyung Soo Chung, Eun Hye Lee, Su Hwan Lee, Sang Hoon Lee, Song Yee Kim, Ji Ye Jung, Young Ae Kang, Moo Suk Park, Young Sam Kim, Joon Chang, Ah Young Leem
Acute Crit Care. 2020;35(1):24-30.   Published online February 29, 2020
DOI: https://doi.org/10.4266/acc.2019.00738
  • 6,956 View
  • 150 Download
  • 4 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Hyperbilirubinemia and hypoalbuminemia are frequently appeared and associated with poor prognosis in critically ill patients. We aim to evaluate the association between the bilirubin to albumin ratio and prognosis in intensive care unit (ICU) patients. Methods: This was a retrospective study of 731 patients who were admitted to the medical intensive care unit (MICU) at a tertiary-care center from July 2015 to September 2017. We analyzed the bilirubin to albumin ratio on admission to the MICU, including clinical characteristics and other examinations. Results: The overall 28-day survival of MICU patients was 69.1%. On univariate analysis, Acute Physiology and Chronic Health Evaluation (APACHE) II score (P<0.001), Sequential Organ Failure Assessment score (P<0.001), Simplified Acute Physiology Score II score (P<0.001), Creactive protein (P=0.015), and bilirubin/albumin ratio (P<0.001) were associated with mortality of ICU patients. The receiver operating characteristic curves for ICU patients mortality between bilirubin to albumin ratio and APACHE II score were not statistically significant (P=0.282). On multivariate analysis, higher APACHE II score (hazard ratio [HR], 1.05; 95% CI, 1.03 to 1.06; P<0.001) and bilirubin to albumin ratio (HR, 1.65; 95% CI, 1.23 to 2.20; P=0.001) were independently related to the ICU patient mortality. Conclusions: A higher bilirubin to albumin ratio was related to the unfavorable prognosis and mortality in critically ill patients.

Citations

Citations to this article as recorded by  
  • Role of serum bilirubin-to-albumin ratio as a prognostic index in critically ill children
    You Min Kang, Ga Eun Kim, Mireu Park, Jong Deok Kim, Min Jung Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Son, Soo Yeon Kim
    Clinical and Experimental Pediatrics.2023; 66(2): 85.     CrossRef
  • Association between total bilirubin/Albumin ratio and all-cause mortality in acute kidney injury patients: A retrospective cohort study
    Ximei Huang, Yunhua Huang, Min Chen, Lin Liao, Faquan Lin, Eranga Sanjeewa Wijewickrama
    PLOS ONE.2023; 18(11): e0287485.     CrossRef
  • The value of albumin-related ratios in predicting disease severity and mortality in acute cholangitis
    Bayram YEŞİL, Bünyamin SEVİM
    Journal of Health Sciences and Medicine.2023; 6(6): 1244.     CrossRef
  • Hepatic dysfunction in critically ill patients
    Jeong Hoon Yang
    Acute and Critical Care.2020; 35(1): 44.     CrossRef
Pediatric
Serum Albumin as a Biomarker of Poor Prognosis in the Pediatric Patients in Intensive Care Unit
Young Suh Kim, In Suk Sol, Min Jung Kim, Soo Yeon Kim, Jong Deok Kim, Yoon Hee Kim, Kyung Won Kim, Myung Hyun Sohn, Kyu-Earn Kim
Korean J Crit Care Med. 2017;32(4):347-355.   Published online November 30, 2017
DOI: https://doi.org/10.4266/kjccm.2017.00437
  • 8,496 View
  • 317 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract PDFSupplementary Material
Background
Serum albumin as an indicator of the disease severity and mortality is suggested in adult patients, but its role in pediatric patients has not been established. The objectives of this study are to investigate the albumin level as a biomarker of poor prognosis and to compare it with other mortality predictive indices in children in intensive care unit (ICU).
Methods
Medical records of 431 children admitted to the ICU at Severance Hospital from January 1, 2012 to December 31, 2015 were retrospectively analyzed. Children who expired within 24 hours after ICU admission, children with hepatic or renal failure, and those who received albumin replacement before ICU admission were excluded.
Results
The children with hypoalbuminemia had higher 28-day mortality rate (24.60% vs. 9.28%, P < 0.001), Pediatric Index of Mortality (PIM) 3 score (9.23 vs. 8.36, P < 0.001), Pediatric Risk of Mortality (PRISM) III score (7.0 vs. 5.0, P < 0.001), incidence of septic shock (12% vs. 3%, P < 0.001), C-reactive protein (33.0 mg/L vs. 5.8 mg/L, P < 0.001), delta neutrophil index (2.0% vs. 0.6%, P < 0.001), lactate level (1.6 mmol/L vs. 1.2 mmol/L, P < 0.001) and lower platelet level (206,000/μl vs. 341,000/μl, P < 0.001) compared to the children with normal albumin level. PIM 3 (r = 0.219, P < 0.001) and PRISM III (r = 0.375, P < 0.001) were negatively correlated with serum albumin level, respectively.
Conclusions
Our results highlight that hypoalbuminemia can be a biomarker of poor prognosis including mortality in the children in ICU.

Citations

Citations to this article as recorded by  
  • Prognostic factors and models to predict pediatric sepsis mortality: A scoping review
    Irene Yuniar, Cut Nurul Hafifah, Sharfina Fulki Adilla, Arifah Nur Shadrina, Anthony Christian Darmawan, Kholisah Nasution, Respati W. Ranakusuma, Eka Dian Safitri
    Frontiers in Pediatrics.2023;[Epub]     CrossRef
  • The association between serum albumin and long length of stay of patients with acute heart failure: A retrospective study based on the MIMIC-IV database
    Tao Liu, Haochen Xuan, Lili Wang, Xiaoqun Li, Zhihao Lu, Zhaoxuan Tian, Junhong Chen, Chaofan Wang, Dongye Li, Tongda Xu, Chiara Lazzeri
    PLOS ONE.2023; 18(2): e0282289.     CrossRef
  • Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS) and Serous Effusions in a Child With Severe Hypoalbuminemia: A Case Report
    Zohair El Haddar, Aziza Elouali, Ilham Belga, Maria Rkain, Abdeladim Babakhouya
    Cureus.2023;[Epub]     CrossRef
  • Inappropriate empirical antibiotic therapy was an independent risk factor of pediatric persistent S. aureus bloodstream infection
    Xingmei Wang, Ziyao Guo, Xi Zhang, Guangli Zhang, Qinyuan Li, Xiaoyin Tian, Dapeng Chen, Zhengxiu Luo
    European Journal of Pediatrics.2022; 182(2): 719.     CrossRef
  • Evaluation of models for predicting pediatric fraction unbound in plasma for human health risk assessment
    Yejin Esther Yun, Andrea N. Edginton
    Journal of Toxicology and Environmental Health, Part A.2021; 84(2): 67.     CrossRef
  • Diabetes Mellitus and Hypertension Increase Risk of Death in Novel Corona Virus Patients Irrespective of Age: a Prospective Observational Study of Co-morbidities and COVID-19 from India
    Anirban Gupta, Neelabh Nayan, Ranjith Nair, Krishna Kumar, Aditya Joshi, Shivangi Sharma, Jasdeep Singh, Rajan Kapoor
    SN Comprehensive Clinical Medicine.2021; 3(4): 937.     CrossRef
  • Overview of Albumin Physiology and its Role in Pediatric Diseases
    Charles B. Chen, Bilasan Hammo, Jessica Barry, Kadakkal Radhakrishnan
    Current Gastroenterology Reports.2021;[Epub]     CrossRef
  • The effect of nutritional status on post-operative outcomes in pediatric otolaryngology-head and neck surgery
    Jordan Luttrell, Matthew Spence, Hiba Al-Zubeidi, Michael J. Herr, Madhu Mamidala, Anthony Sheyn
    International Journal of Pediatric Otorhinolaryngology.2021; 150: 110875.     CrossRef
Case Report
Liver/Infection
Chylous Ascites in a Patient with Sepsis Caused by Bilateral Pneumonia
Yong Dae Lee, Young Hyun Lee, Hye Sook Choi
Korean J Crit Care Med. 2014;29(3):217-221.   Published online August 31, 2014
DOI: https://doi.org/10.4266/kjccm.2014.29.3.217
  • 12,874 View
  • 85 Download
  • 1 Crossref
AbstractAbstract PDF
Chylous ascites is a rare form of ascites characterized by milky peritoneal fluid rich in triglycerides due to the accumulation of chyle in the peritoneal cavity. This affliction occurs as a result of a disruption of lymph flow associated with traumatic injury or obstruction of the lymphatic system. There are various causes of chylous ascites, such as lymphatic anomalies, malignancy, cirrhosis, infection, trauma, surgery, and nephrotic syndrome. We report a rare case of an 81-year-old male with sepsis caused by bilateral pneumonia who presented with chylous ascites.

Citations

Citations to this article as recorded by  
  • Diagnostic and management problems of chylous effusion in a patient with newly-diagnosed tuberculosis
    Dicky Febrianto, Usman Hadi
    Current Internal Medicine Research and Practice Surabaya Journal.2021; 2(2): 35.     CrossRef
Original Article
Clinical Significance of Postoperative Prealbumin and Albumin Levels in Critically Ill Patients who Underwent Emergency Surgery for Acute Peritonitis
Seung Hwan Lee, Ji Young Jang, Jae Gil Lee
Korean J Crit Care Med. 2013;28(4):247-254.
DOI: https://doi.org/10.4266/kjccm.2013.28.4.247
  • 3,182 View
  • 42 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Many studies have shown that serum albumin and prealbumin levels correlate with patient outcomes in critically ill patients. The purpose of this study was to evaluate the clinical significance of prealbumin and albumin levels in patients in the intensive care unit (ICU) after emergency surgery for acute peritonitis.
METHODS
We examined serum albumin and prealbumin as markers for the prediction of patient outcome in 51 patients admitted to the ICU after emergency surgery from January to December in 2012. Biochemical parameters were measured postoperatively. Serum albumin and prealbumin levels were compared between survivors and non-survivors. Patients were also divided according to the occurrence of shock and pulmonary complications (shock group vs. non-shock group, pulmonary complications group vs. non-pulmonary complications group), and outcome analysis was performed for age, American Society of Anesthesiologists (ASA) score, length of ICU stay (IS), length of hospital stay (HS), mechanical ventilation, and APACHE II score. Serum albumin and prealbumin levels were evaluated for any correlation with complications and mortality.
RESULTS
In patients with shock, prealbumin and albumin were significantly decreased (p = 0.047, p = 0.036). Additionally, albumin was significantly decreased in patients with pulmonary complications. Neither albumin nor prealbumin, however, showed a correlation with mortality. Prealbumin showed a correlation with serum albumin, CRP level, and HS (r = 0.511, p < 0.001; r = -0.438, p = 0.002; and r = -0.45, p = 0.001, respectively). Albumin showed a correlation with HS, IS, and APACHE II score (r = -0.404, p = 0.003; r = -0.424, p = 0.002; and r = -0.40, p = 0.006, respectively).
CONCLUSIONS
The initial prealbumin level measured upon admission to the ICU after gastrointestinal emergency surgery can be useful predictor of shock. The initial albumin level was significantly low in patients with shock and pulmonary complications. However, neither prealbumin nor albumin showed a correlation with mortality. Our study also showed that albumin and prealbumin levels are affected by other factors, such as massive hydration and severe inflammation, as reported in previous studies.

Citations

Citations to this article as recorded by  
  • Perioperative risk factors for in-hospital mortality after emergency gastrointestinal surgery
    Jin Young Lee, Seung Hwan Lee, Myung Jae Jung, Jae Gil Lee
    Medicine.2016; 95(35): e4530.     CrossRef

ACC : Acute and Critical Care