title: 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 (Mg(2+)) 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden ;|b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden ;
authors.forename: Fredrik
authors.initials: F
authors.lastname: Helliksson
authors.affiliation: a Department of Clinical Science , Intervention, and Technology, CLINTEC, Karolinska Institutet , Stockholm , Sweden ;
authors.forename: Jan
authors.initials: J
authors.lastname: Wernerman
authors.affiliation: c Department of Surgical Sciences , Uppsala University , Uppsala , Sweden ;
authors.forename: Lars
authors.initials: L
authors.lastname: Wiklund
authors.affiliation: b Department of Anesthesiology and Intensive Care , Central Hospital , Karlstad , Sweden ;
authors.forename: Jon
authors.initials: J
authors.lastname: Rosell
authors.affiliation: d Department of Clinical Science and Education , Karolinska Institutet Södersjukhuset , Stockholm , Sweden ;|e Department of Clinical Chemistry , Central Hospital , Karlstad , Sweden.
authors.forename: Mathias
authors.initials: M
authors.lastname: Karlsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D007902:Length of Stay; D008274:Magnesium / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D012709:Serum Albumin; D007770:L-Lactate Dehydrogenase; D008274:Magnesium
keywords: Biomarkers; critical care; lactate dehydrogenases; multiple organ failure; organ dysfunction scores