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[Feasibility study of the difference between hematocrit and albumin for identifying hemorrhagic shock and septic shock].

OBJECTIVE
To observe the difference between hematocrit (Hct) and albumin (Alb) levels (Hct-Alb) in hemorrhagic shock and septic shock, and to provide a quick and simple method for differentiating hemorrhagic shock from septic shock.


METHODS
270 shock patients admitted to intensive care unit (ICU) of the First Affiliated Hospital of Kunming Medical University from August 2012 to August 2018, including 124 patients with hemorrhagic shock and 148 patients with septic shock, were enrolled. 148 patients underwent routine physical examination served as a control healthy group. General information such as gender, age, and body mass index (BMI) of the patient were collected. Hct and serum Alb levels on the day of physical examination or onset before blood products transfusion were recorded, and the Hct-Alb difference was calculated. The Hct-Alb differences among the three groups were compared. The receiver operating characteristic (ROC) curve was plotted to analyze the differential diagnosis value of Hct-Alb difference for shock type.


RESULTS
All patients were enrolled in the final analysis. Compared with the healthy control group, the patients with hemorrhagic and septic shock were older (years: 50.0±19.8, 59.9±16.9 vs. 42.5±13.6, both P < 0.01), and those patients with septic shock was significantly older than those with hemorrhagic shock (years: 59.9±16.9 vs. 50.0±19.8, P < 0.01). There were no significant differences in gender or BMI among the three groups. Compared with the healthy control group, Hct and Alb values in hemorrhagic shock group and septic shock group were significantly decreased [Hct: (27.9±8.4)%, (35.5±7.1)% vs. (47.0±4.4)%, Alb (g/L): 28.9±7.1, 23.3±5.8 vs. 45.4±4.3, all P < 0.01]. The Hct-Alb difference in the septic shock group was significantly higher than that in the healthy control group (12.1±7.5 vs. 1.6±5.9, P < 0.01), but no significant difference was found between hemorrhagic shock group and healthy control group (-0.9±5.3 vs. 1.6±5.9, P > 0.05). Compared with hemorrhagic shock group, the Alb level in septic shock group was significantly decreased (g/L: 23.3±5.8 vs. 28.9±7.1, P < 0.01), and Hct and Hct-Alb difference were significantly increased [Hct: (35.5±7.1)% vs. (27.9±8.4)%, Hct-Alb difference: 12.1±7.5 vs. -0.9±5.3, both P < 0.01]. It was shown by ROC curve analysis that the area under the ROC curve (AUC) for diagnosing hemorrhagic shock and septic shock was 0.366 and 0.867, indicating that Hct-Alb difference had diagnostic value only for septic shock. When the best cut-off value of Hct-Alb difference was 6.8, the sensitivity was 79.5% for diagnosing septic shock, and the specificity was 79.7%, the positive predict value was 0.80, the negative predict value was 0.80, the positive likelihood ratio was 3.916, the negative likelihood ratio was 0.257.


CONCLUSIONS
The Hct-Alb difference in patients with septic shock is higher than that in patients with hemorrhagic shock. The Hct-Alb difference is highly accurate in diagnosing septic shock. When the Hct-Alb difference is greater than 6.8, it can be used for differential diagnosis of hemorrhagic shock and septic shock.