Serum lactate/albumin ratio at hospital arrival and neurological outcomes in patients who received targeted temperature management after out‐of‐hospital cardiac arrest: A nationwide, multicenter, observational study

Background A lower serum lactate/albumin ratio has been linked to favorable outcomes in critically ill patients. Objective We investigated whether the serum lactate/albumin ratio could predict the likelihood of benefiting from targeted temperature management (TTM) after out‐of‐hospital cardiac arrest (OHCA). Methods Using a nationwide Japanese registry, we reviewed patients aged ≥18 years with OHCA of medical cause who received TTM during the study period. The patients were grouped by serum lactate/albumin ratio quartile at hospital arrival (first quartile, ≤1.77, n = 219; second quartile, 1.77 to ≤2.59, n = 211; third quartile, 2.59 to ≤3.62, n = 212; fourth quartile, >3.62, n = 191) for targeted temperatures of ≤34°C and ≥35°C. The primary outcome was 30‐day survival with favorable neurological outcomes, defined as Cerebral Performance Category scores of 1 or 2. Results The targeted temperature was ≤34°C in 833 patients and ≥35°C in 437 patients. Multivariable logistic regression analysis in the ≤34°C subgroup illustrated that patients in the second [adjusted odds ratio (AOR) = 0.60, 95% confidence interval (CI) = 0.36–0.99], third (AOR = 0.24, 95% CI = 0.14–0.39), and fourth quartiles (AOR = 0.12, 95% CI = 0.06–0.22) had lower odds of favorable neurological outcomes than those in the first quartile. Similar results were obtained in the ≥35°C subgroup ( p for interaction = 0.86). Conclusions Among patients who received TTM after OHCA, those in the lowest serum lactate/albumin ratio quartile at hospital admission experienced significantly better neurological outcomes.