The Prognostic Usefulness of The Lactate/Albumin Ratio For Predicting Clinical Outcomes In Out-Of-Hospital Cardiac Arrest: A Prospective, Multicentre Observational Study (KoCARC Study).

We aimed to evaluate the lactate/albumin ratio (LAR) to identify its significance as a prognostic marker for favourable neurologic outcome and survival in patients with return of spontaneous circulation after out-of-hospital cardiac arrest (OHCA). Based on the LAR and multiple parameters, we developed new nomograms and externally validated the tools.We conducted an observational study using a prospective, multicentre registry of out-of-cardiac arrest resuscitation provided by the Korean Cardiac Arrest Research Consortium registry from October 2015 to June 2017.A total of 524 patients were included in this study. An increased LAR was significantly associated with decreased favourable neurologic outcomes (odds ratio [OR] 0.787; 95% confidence interval [CI] 0.630-0.983; P = 0.035) and survival at discharge (OR 0.744; 95% CI 0.638-0.867; P < 0.001). The areas under the curve (AUCs) for predicting neurologic outcome and survival to discharge using the LAR were 0.824 (P < 0.001) and 0.781 (P < 0.001), respectively. A LAR value of more than the optimal cut-off values of 2.82 and 3.62 could significantly improve prediction of decreased favourable neurologic outcome and survival to discharge, respectively. We constructed nomograms based on the multivariate logistic model. The model for predicting favourable neurologic outcomes and survival discharge had AUCs of 0.927 (P < 0.001) and 0.872 (P < 0.001), respectively.The prognostic performance of the LAR was superior to a single measurement of lactate for predicting favourable neurologic outcomes and survival to discharge after OHCA. The newly developed nomograms can provide rapid prediction of probability of clinical outcomes.