The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury
Abstract Background/objectives Sepsis-related acute kidney injury (SA-AKI) is a severe condition characterized by high mortality rates. The utility of the sCAR (secrum creatinine/albumin) and LAR (Lactate dehydrogenase/albumin) as diagnostic markers for persistent severe SA-AKI remains unclear. Meth...
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BMC
2025-01-01
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| Series: | European Journal of Medical Research |
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| Online Access: | https://doi.org/10.1186/s40001-024-02269-6 |
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| author | Xiaoxiao Luo Dongyang Liu Cuicui Li Jia Liao Wuyang Lv Yuchen Wang Ruxue Diao Yingyu Jin |
| author_facet | Xiaoxiao Luo Dongyang Liu Cuicui Li Jia Liao Wuyang Lv Yuchen Wang Ruxue Diao Yingyu Jin |
| author_sort | Xiaoxiao Luo |
| collection | DOAJ |
| description | Abstract Background/objectives Sepsis-related acute kidney injury (SA-AKI) is a severe condition characterized by high mortality rates. The utility of the sCAR (secrum creatinine/albumin) and LAR (Lactate dehydrogenase/albumin) as diagnostic markers for persistent severe SA-AKI remains unclear. Methods We acquired training set data from the MIMIC-IV database and validation set data from the First Affiliated Hospital of Harbin Medical University. Logistic regression analysis was used to identify key predictors of persistent severe SA-AKI, considering factors such as sCAR, LAR, PAR (Platelet/albumin), BAR (BUN/albumin), and LAO (Lactic/albumin). Independent predictors, sCAR and LAR, were combined into a composite Log(sCAR)_Log(LAR) score, denoted as the Log(sCAR)_Log(LAR) score. Possible confounding factors were screened out by univariate logistic regression, and multivariable logistic regression was applied to evaluate the association of Log (sCAR) _Log (LAR) score with persistent severe sepsis and other secondary clinical outcomes. The ROC curve was utilized to obtain the best cutoff value of the Log(sCAR)_Log(LAR) score. The Kaplan–Meier curve was used to evaluate the prognosis predictive ability of the risk model. Results Logistic regression analysis indicated that sCAR and LAR independently predicted persistent severe SA-AKI. This led to the creation of Log(sCAR)_Log(LAR) score on the base of logarithms of sCAR and LAR. ROC curve analysis showed that the Log(sCAR)_Log(LAR) score was more effective in predicting persistent severe SA-AKI (AUC = 0.71) than Log(sCAR) (AUC = 0.69), Log(LAR) (AUC = 0.65), SOFA score (AUC = 0.66) and Δ Scr (AUC = 0.70). Multivariate regression identified that the SOFA score, PT, ΔScr, Tbil, chronic liver disease, and Vasopressor use as independent risk factors for persistent severe SA-AKI (P < 0.05). A basic clinical prediction model was created using these variables, and its predictive ability, recognition capability, and clinical utility improved with the inclusion of the Log(sCAR)_Log(LAR) score. The model's predictive ability for secondary outcomes, such as renal replacement therapy (RRT), also improved with the addition of the Log(sCAR)_Log(LAR) score. The sensitivity analysis further corroborated the stability of the Log(sCAR)_Log(LAR) score in predicting persistent severe SA-AKI and secondary outcomes, such as RRT. Conclusions The Log(sCAR)_Log(LAR) score effectively predicted persistent severe SA-AKI, potentially aiding intensive care physicians in risk assessment. |
| format | Article |
| id | doaj-art-7dba4c824c2c43ebb3a4e7bcfcfc9360 |
| institution | Kabale University |
| issn | 2047-783X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
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| series | European Journal of Medical Research |
| spelling | doaj-art-7dba4c824c2c43ebb3a4e7bcfcfc93602025-01-19T12:14:55ZengBMCEuropean Journal of Medical Research2047-783X2025-01-0130112010.1186/s40001-024-02269-6The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injuryXiaoxiao Luo0Dongyang Liu1Cuicui Li2Jia Liao3Wuyang Lv4Yuchen Wang5Ruxue Diao6Yingyu Jin7First Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityFirst Affiliated Hospital of Harbin Medical UniversityAbstract Background/objectives Sepsis-related acute kidney injury (SA-AKI) is a severe condition characterized by high mortality rates. The utility of the sCAR (secrum creatinine/albumin) and LAR (Lactate dehydrogenase/albumin) as diagnostic markers for persistent severe SA-AKI remains unclear. Methods We acquired training set data from the MIMIC-IV database and validation set data from the First Affiliated Hospital of Harbin Medical University. Logistic regression analysis was used to identify key predictors of persistent severe SA-AKI, considering factors such as sCAR, LAR, PAR (Platelet/albumin), BAR (BUN/albumin), and LAO (Lactic/albumin). Independent predictors, sCAR and LAR, were combined into a composite Log(sCAR)_Log(LAR) score, denoted as the Log(sCAR)_Log(LAR) score. Possible confounding factors were screened out by univariate logistic regression, and multivariable logistic regression was applied to evaluate the association of Log (sCAR) _Log (LAR) score with persistent severe sepsis and other secondary clinical outcomes. The ROC curve was utilized to obtain the best cutoff value of the Log(sCAR)_Log(LAR) score. The Kaplan–Meier curve was used to evaluate the prognosis predictive ability of the risk model. Results Logistic regression analysis indicated that sCAR and LAR independently predicted persistent severe SA-AKI. This led to the creation of Log(sCAR)_Log(LAR) score on the base of logarithms of sCAR and LAR. ROC curve analysis showed that the Log(sCAR)_Log(LAR) score was more effective in predicting persistent severe SA-AKI (AUC = 0.71) than Log(sCAR) (AUC = 0.69), Log(LAR) (AUC = 0.65), SOFA score (AUC = 0.66) and Δ Scr (AUC = 0.70). Multivariate regression identified that the SOFA score, PT, ΔScr, Tbil, chronic liver disease, and Vasopressor use as independent risk factors for persistent severe SA-AKI (P < 0.05). A basic clinical prediction model was created using these variables, and its predictive ability, recognition capability, and clinical utility improved with the inclusion of the Log(sCAR)_Log(LAR) score. The model's predictive ability for secondary outcomes, such as renal replacement therapy (RRT), also improved with the addition of the Log(sCAR)_Log(LAR) score. The sensitivity analysis further corroborated the stability of the Log(sCAR)_Log(LAR) score in predicting persistent severe SA-AKI and secondary outcomes, such as RRT. Conclusions The Log(sCAR)_Log(LAR) score effectively predicted persistent severe SA-AKI, potentially aiding intensive care physicians in risk assessment.https://doi.org/10.1186/s40001-024-02269-6SepsisAcute kidney injuryAlbuminCreatinineLactate dehydrogenase |
| spellingShingle | Xiaoxiao Luo Dongyang Liu Cuicui Li Jia Liao Wuyang Lv Yuchen Wang Ruxue Diao Yingyu Jin The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury European Journal of Medical Research Sepsis Acute kidney injury Albumin Creatinine Lactate dehydrogenase |
| title | The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury |
| title_full | The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury |
| title_fullStr | The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury |
| title_full_unstemmed | The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury |
| title_short | The predictive value of the serum creatinine-to-albumin ratio (sCAR) and lactate dehydrogenase-to-albumin ratio (LAR) in sepsis-related persistent severe acute kidney injury |
| title_sort | predictive value of the serum creatinine to albumin ratio scar and lactate dehydrogenase to albumin ratio lar in sepsis related persistent severe acute kidney injury |
| topic | Sepsis Acute kidney injury Albumin Creatinine Lactate dehydrogenase |
| url | https://doi.org/10.1186/s40001-024-02269-6 |
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