Introduction. The lactate/albumin ratio is an inflammatory biomarker that has been widely used and suggested as a predictor of mortality in patients with sepsis and septic shock. However, the results are inconsistent. This meta-analysis aimed to evaluate the prognostic value of lactate/albumin ratio as a predictor of mortality in patients with sepsis and septic shock.Methods. The study protocol was registered with PROSPERO (CRD42021286242). A literature search was performed using PubMed, Ovid EMBASE, Ovid MEDLINE, SCOPUS, and Web of Sciences to find all studies evaluating the association between lactate/albumin ratio and mortality in patients with sepsis and septic shock. Meta-analysis was performed to synthesize the overall Standardized Mean Difference (SMD) of the lactate/albumin ratio and the pooled Odds Ratio (OR) for mortality with 95% confidence intervals (95% CI). Heterogeneity was assessed using I2. Publication bias was assessed quantitatively with Egger’s test. Analysis was performed using Stata version 16.Results. Seven studies (n=10,264 patients) were included in the meta-analysis. The meta-analysis results showed that non-survivor had a higher lactate/albumin ratio than survivor (random-effects model; SMD 1.47; 95% CI 0,91-2,04; p <0.001). Higher lactate/albumin ratio was associated with an increased mortality in sepsis and septic shock patients (fixed-effects model; OR 1.49 (95% CI 1.37-1.62); p <0.001).Conclusions. High lactate/albumin ratio was associated with mortality in sepsis and septic shock patients. Thus, lactate/albumin ratio can be used as a predictor biomarker in predicting mortality for sepsis and septic shock patients.


1. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: For the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016:23;315:762-74.2. Dugani S, Veillard J, Kissoon N. Reducing the global burden of sepsis. CMAJ. 2017;189(1):E2-3. 3. Thapa S, Prasad PN, Shakya YM. Serum lactate albumin ratio as a predictor of mortality in severe sepsis and septic shock at Tribhuwan University Teaching Hospital, Kathmandu. Birat J Health ci. 2017;2(2):191-5.4. Van Engelen TSR, Wiersinga WJ, Scicluna BP, van der Poll T. Biomarkers in sepsis. Crit Care Clin. 2018;34(1):139-52.5. Brodska H, Valenta J, Pelinkova K, Stach Z, Sachl R, Balik M, et al. Diagnostic and prognostic value of presepsin vs. established biomarkers in critically ill patients with sepsis or systemic inflammatory response syndrome. Clin Chem Lab Med. 2018;56(4):658-68.6. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020;38(3):641-7.7. Erdoğan M, Findikli HA. Prognostic value of the lactate/albumin ratio for predicting mortality in patients with pneumosepsis in intensive care units. Medicine (Baltimore). 2022;101(4):e28748.8. Garcia-Alvarez M, Marik P, Bellomo R. Sepsis-associated hyperlactatemia. Crit Care. 2014;18(5):503. 9. Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):486–552.10. Ranzani OT, Zampieri FG, Forte DN, Azevedo LC, Park M. C-reactive protein/albumin ratio predicts 90-day mortality of septic patients. PLoS One. 2013;8(3):e59321.11. Gounden V, Vashisht R, Jialal I. Hypoalbuminemia. Treasure Island (FL): StatPearls Publishing; 2021.12. Wang B, Chen G, Cao Y, Xue J, Li J, Wu Y. Correlation of lactate/albumin ratio level to organ failure and mortality in severe sepsis and septic shock. J Crit Care. 2015;30:271–5. 13. Yin M, Si L, Qin W, Li C, Zhang J, Yang H, Han H, et al. Predictive value of serum albumin level for the prognosis of severe sepsis without exogenous human albumin administration: a prospective cohort study. J Intensive Care Med. 2018;33(12):687-94.14. Haas SA, Lange T, Saugel B, Petzoldt M, Fuhrmann V, Metschke M, Kluge S. Severe hyperlactatemia, lactate clearance and mortality in unselected critically ill patients. Intensive Care Med. 2016;42(2):202-10.15. Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clin Proc. 2013;88(10):1127-40.16. Caironi P, Langer T, Gattinoni L. Albumin in critically ill patients: the ideal colloid? Curr Opin Crit Care. 2015;21(4):302-8.17. Lichtenauer M, Wernly B, Ohnewein B, Franz M, Kabisch B, Muessig J, et al. The Lactate/albumin ratio: a valuable tool for risk stratification in septic patients admitted to ICU. Int J Mol Sci. 2017;18(9):1893.18. Bou Chebl R, Jamali S, Sabra M, Safa R, Berbari I, Shami A, et al. Lactate/albumin ratio as a predictor of in-hospital mortality in septic patients presenting to the emergency department. Front Med (Lausanne). 2020;7:550182.19. Lu Y, Guo H, Chen X, Zhang Q. Association between lactate/albumin ratio and all-cause mortality in patients with acute respiratory failure: A retrospective analysis. PLoS ONE. 2021;16(8):e0255744.20. Gharipour A, Razavi R, Gharipour M, Mukasa D. Lactate/albumin ratio: An early prognostic marker in critically ill patients. Am J Emerg Med. 2020;38(10):2088-95.21. Shin J, Hwang SY, Jo IJ, Kim WY, Ryoo SM, Kang GH, et al. Prognostic value of the lactate/albumin ratio for predicting 28-day mortality in critically ill sepsis patients. Shock. 2018;50(5):545-50.22. Rahajeng EP, Handayani I, Esa T, Bahrun U. Analisis laktat, albumin dan rasio laktat albumin sebagai prediktor luaran pada pasien sepsis dan syok septik di RSUP Dr. Wahidin Sudirohusodo Makassar. J Kes Andalas. 2020;9(1):26-32. 23. Lo CK, Mertz D, Loeb M. Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments. BMC Med Res Methodol. 2014 Apr 1;14:45 24. Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA. Cochrane handbook for systematic reviews of interventions version 6.2. London, UK: Cochrane; 2021.25. Macaskill P, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Stat Med. 2001;20(4):641-54.26. Sterne JA, Gavaghan D, Egger M. Publication and related bias in meta-analysis: power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000;53(11):1119-29. 27. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5(1):13.28. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. 29. Cakir E, Turan IO. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis. Scand J Clin Lab Invest. 2021;81(3):225-9.30. Makram EF, Ibrahim ME, Abdel Rahman AH, Aboraya KM. Serum lactate/albumin ratio as a predictor of morbidity and mortality in patients with severe sepsis and septic shock. Benha Med J. 2020;37(1):220-8.31. Mishra LS, Kumar RB, Illahi MT. Serum lactate/albumin ratio as a predictor of organ failure and mortality in severe sepsis and septic shock. Int J Sci Res. 2018;7(11):72-4.32. Yucel K, Gurbuz AF. The effect of lactate/albumin ratio on mortality in patients with sepsis. Medscience. 2021;10(3):939-45.33. Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992;20(1):80–93.34. Levy B, Gibot S, Franck P, Cravoisy A, Bollaert PE. Relation between muscle Na+K+ ATPase activity and raised lactate concentrations in septic shock: a prospective study. Lancet. 2005;365(9462):871–5.35. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37(5):1670-7.36. Oh DH, Kim MH, Jeong WY, Kim YC, Kim EJ, Song JE, et al. Risk factors for mortality in patients with low lactate level and septic shock. J Microbiol Immunol Infect. 2019;52(3):418-25.37. Gatta A, Verardo A, Bolognesi M. Hypoalbuminemia. Intern EmergMed. 2012;7(Suppl 3):S193-9. 38. Arnau-Barrés I, Güerri-Fernández R, Luque S, Sorli L, Vázquez O, Miralles R. Serum albumin is a strong predictor of sepsis outcome in elderly patients. Eur J Clin Microbiol Infect Dis. 2019;38(4):743-6.39. Artero A, Zaragoza R, Camarena JJ, Sancho S, Gonzalez R, Nogueira JM. Prognostic factors of mortality in patients with community-acquired bloodstream infection with severe sepsis and septic shock. J Crit Care. 2010;25:276-81.40. Magnussen B, Oren Gradel K, Gorm Jensen T, Kolmos HJ, Pedersen C, Just Vinholt P, et al. Association between hypoalbuminaemia and mortality in patients with community-acquired bacteraemia is primarily related to acute disorders. PloS One. 2016;11(9):e0160466.41. Ballmer-Weber BK, Dummer R, Kung E, Burg G, Ballmer PE. Interleukin 2-induced increase of vascular permeability without decrease of the intravascular albumin pool. Br J Cancer. 1995;71(1):78-82.42. Doweiko JP, Nompleggi DJ. The role of albumin in human physiology and pathophysiology, part III: albumin and disease states. JPEN J Parenter Enteral Nutr. 1991;15(4):476-83.43. Sitar ME, Aydin S, Cakatay U. Human serum albumin and its relation with oxidative stress. Clin Lab. 2013;59(9-10):945-52.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.