Association of Early post-ECMO lactate-to-albumin Ratio and its Dynamic Changes with Mortality: A Retrospective Cohort Study
DOI:
https://doi.org/10.54097/hw966z93Keywords:
Albumin, Extracorporeal Membrane Oxygenation, Lactate, Lactate-to-albumin RatioAbstract
Extracorporeal membrane oxygenation is used for severe cardiac or respiratory failure, yet early risk assessment remains difficult. We examined whether the lactate-to-albumin ratio measured early after extracorporeal membrane oxygenation initiation and its change from intensive care unit baseline were associated with adjudicated mortality. This single-center retrospective cohort included adults receiving extracorporeal membrane oxygenation in the intensive care unit between 2022 and 2024. The ratio was calculated as 10 times lactate in millimoles per liter divided by albumin in grams per liter. The primary exposure was the available ratio measured within the first 24 hours after support initiation closest to the 24-hour time point. Missing data were handled using multiple imputation by chained equations with predictive mean matching, yielding five completed datasets. Logistic regression, restricted cubic spline analysis, receiver operating characteristic analysis, and sensitivity analyses were performed. Among 84 patients, 57 were classified as non-survivors and 27 as survivors. In the fully adjusted model, each one-unit increase in the early post-extracorporeal membrane oxygenation ratio was associated with 53.3% higher odds of mortality (odds ratio 1.533, 95% confidence interval 1.136–2.069; P = 0.006). Spline analysis identified an overall association and no statistically significant departure from linearity. The intensive care unit baseline ratio was not associated with mortality, whereas a greater absolute increase in the ratio was associated with higher odds of mortality. In exploratory tertile analysis, the proportion of non-survivors increased from 52.8% to 61.8% and 89.1% across increasing relative-change groups (P for trend = 0.005). The area under the receiver operating characteristic curve for the ratio was 0.794, with no significant difference from lactate alone. Early post-extracorporeal membrane oxygenation lactate-to-albumin ratio and its trajectory were associated with mortality; prospective external validation is needed.
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