Evaluation of the relationship between the lactate/albumin ratio, CRP/albumin ratio, SOFA score, and qSOFA score in patients diagnosed with sepsis/septic shock in the emergency department and their 28-day mortality

Sepsis is a systemic clinical picture characterized by life-threatening organ dysfunction as a result of dysregulation of the host response to infection. Early diagnosis and treatment are among the most critical factors determining the course of the disease. Sepsis, which is frequently encountered in intensive care units, is still an important health problem due to its high mortality rates. In this context, the use of biomarkers and clinical scoring systems for early diagnosis and prognosis prediction of sepsis plays a decisive role in clinical decision-making processes. In recent years, the SOFA (Sequential Organ Failure Assessment) score has been recognized as one of the gold standards for the assessment of organ dysfunction in patients with sepsis. At the same time, biochemical parameters such as lactate/albumin ratio have been shown to have potential in predicting sepsis prognosis. This ratio is noteworthy in terms of reflecting both tissue perfusion impairment and nutritional and inflammatory status. The aim of this study was to retrospectively evaluate the effect of SOFA score and lactate/albumin ratio on 28-day mortality in patients diagnosed with sepsis or septic shock according to Sepsis-3 diagnostic criteria in the emergency department and hospitalized in the tertiary intensive care unit. We also aimed to reveal the potential value of these parameters in predicting prognosis in patients with sepsis. Our study was conducted in a retrospective and descriptive design. Patients aged 18 years and older who presented to the emergency department of a tertiary university hospital between September 2021 and September 2024 and were hospitalized in the intensive care unit with a diagnosis of sepsis or septic shock according to Sepsis-3 criteria were included in the study. Patients whose intensive care unit admission was made to an external center and patients with missing data were excluded. Demographic data, vital signs, comorbidities, laboratory results, SOFA score, qSOFA score, lactate level, albumin level and lactate/albumin ratio were collected by reviewing the electronic medical records of the patients. The primary endpoint was 28-day mortality. In the statistical analysis of the data, parametric and non-parametric tests were used appropriately and variables associated with mortality were evaluated. Statistical significance level was accepted as p<0.05. Between September 2021 and September 2024, data of 291 patients who were admitted to the emergency department of a tertiary university hospital and diagnosed with sepsis or septic shock according to Sepsis-3 criteria were analyzed. 150 patients were excluded from the study, and the data of 141 patients were recorded and included in the study. Demographic data (age, gender), vital signs (blood pressure, heart rate, body temperature, peripheral oxygen saturation), comorbid diseases (malignancy, chronic renal failure), laboratory parameters (blood lactate level, serum albumin level, CRP level), SOFA score, qSOFA score and lactate/albumin ratio and CRP/albumin ratio, presence of mortality and the number of days following admission to the intensive care unit, if any. When the patients included in the study were compared according to gender and pulse rate, systolic blood pressure and saturation at admission, no significant difference was found in terms of mortality. When compared according to the need for supportive treatment, patients requiring intubation had a more mortal course, while no significant difference was found in the mortality frequency of patients requiring inotropes compared to other patients. Patients with a diagnosis of malignancy had a more mortal prognosis. No significant difference was found between infective foci and mortality frequency. As an important finding of our study, it was observed that lactate elevation and LAR had an effect on both mortality and mortality day. Similar to LAR, SOFA score had an effect on both mortality and mortality day. CRP had no effect on mortality and mortality day, while CAR had a weak effect on mortality but no effect on mortality day. In conclusion, this study shows that the evaluation of biochemical ratios such as LAR and CAR together with clinical scoring such as SOFA and qSOFA is of great importance for early risk stratification, prediction of prognosis and timely determination of appropriate treatment strategies in patients with sepsis. In particular, LAR was found to be highly associated with mortality and may be a stronger prognostic marker compared to other parameters.