The combined use of three widely available biochemical markers as predictor of organ failure in critically ill patients

Abstract

Background: We hypothesized that lactate dehydrogenase, LDH/albumin ratio in combination with or without magnesium (Mg²⁺) could predict organ failure in critically ill adult patients. The aim of this study was to describe a new risk index for organ failure or mortality in critically ill patients based on a combination of these routinely available biochemical plasma biomarkers.

Methods: Patients ≥ 18 years admitted to the intensive care unit (ICU) were screened. Albumin and LDH were analyzed at the time of admission to ICU (n = 347). Organ failure assessed with ‘Sequential Organ Failure Assessment’ (SOFA) score was used, and 30-day mortality was recorded. The predictive value of the test was calculated using the areas under the receiving operating characteristic (ROC) curve.

Results: The LDH/albumin ratio was higher in patients who developed organ failure as compared to those who did not (p < 0.001). The areas under the ROC curve were 0.77 both for prediction of multiple organ failure and for 30-day mortality. In a subgroup of patients (n = 183) admitted to ICU from the emergency department, the predictive values were 0.86 and 0.80, respectively.

Conclusion: The LDH/albumin ratio at ICU admission was associated with the development of multiple organ failure and 30-day mortality in this prospective study. The clinical value of this biomarker as a predictor of organ failure in critically ill patients is yet to be defined.

Keywords:

• Biomarkers
• critical care
• lactate dehydrogenases
• multiple organ failure
• organ dysfunction scores

Acknowledgements

The Center for Clinical Research at the County Council of Värmland, Sweden, supported this work. Thanks to Tara Zaferanlou for language editing. Many thanks to the staff in our ICU.

Disclosure statement

The authors F.H., J.W., L.W. or J.R. report no conflicts of interest. MK is the founder and co-owner of a medical-technology start-up company (http://www.calmark.se) that develops diagnostic devices for point-of-care analysis of LDH and may therefore gain future benefits from the results of the present trial. The authors alone are responsible for the content and writing of the paper.