Lactate Dehydrogenase to Albumin Ratio as a Risk Factor for Acute Kidney Injury in Patients with Sepsis: An Observational Study

ABSTRACT Introduction: Acute kidney injury (AKI) is a frequent and serious complication of sepsis, and creatinine and urine output rise late. The lactate dehydrogenase to albumin ratio (LAR) combines a marker of cellular injury with a marker of inflammation and capillary leak, and may help identify patients at risk. Data from Indian patients are limited. This study evaluated whether baseline LAR is associated with AKI in sepsis and with illness severity and in-hospital mortality. Methodology: This prospective observational study at the Department of General Medicine, Government Medical College, Kota, enrolled 90 adults with sepsis (Sepsis-3). Serum LDH and albumin were measured at baseline and LAR was calculated. AKI was defined by KDIGO criteria within 7 days. LAR was compared between patients with and without AKI, its discriminatory ability was assessed by receiver operating characteristic (ROC) analysis, and its correlation with the SOFA score and its relation to in-hospital mortality were examined. Results: Of 90 patients (mean age 56.8 ± 14.2 years; 64.4% male), 50 (55.6%) developed AKI. Patients with AKI had a higher LAR (33.4 ± 11.2 vs 18.2 ± 7.6; p < 0.001), lower albumin (2.6 ± 0.5 vs 3.2 ± 0.6 g/dL; p < 0.001), higher SOFA score (10.2 ± 3.1 vs 6.4 ± 2.3; p < 0.001) and higher in-hospital mortality (40.0% vs 10.0%; p = 0.001). LAR predicted AKI with an area under the ROC curve of 0.81, at a cut-off of 19.1 or more. LAR correlated positively with SOFA score (r = 0.62). Mortality was 33.3% in the high-LAR half and 20.0% in the low-LAR half, a difference that was not statistically significant. Conclusion: A higher admission LAR was associated with AKI and greater illness severity in sepsis. LAR is a simple, inexpensive index from routine tests that may help early risk stratification, but larger multicentre studies with adjusted analysis are needed to confirm it. Keywords: Sepsis; Acute Kidney Injury; Lactate Dehydrogenase; Serum Albumin; LDH-to-Albumin Ratio; SOFA Score; KDIGO Criteria; Risk Stratification; In-Hospital Mortality.