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The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients
Christopher C Ray1, Murray M Pollack2, Jiaxiang Gai3
1Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC.
Insights
The lactate-albumin ratio (LAR) effectively predicts mortality and multiple organ dysfunction syndrome (MODS) in critically ill children. Early LAR measurement offers superior prognostic value compared to lactate or albumin alone.
Area of Science:
- Pediatric Critical Care Medicine
- Biomarker Research
- Prognostic Indicators
Background:
- Critically ill pediatric patients face significant risks of mortality and multiple organ dysfunction syndrome (MODS).
- Early identification of patients at high risk is crucial for timely intervention and improved outcomes.
- Lactate and albumin are established biomarkers, but their individual predictive power may be limited.
Purpose of the Study:
- To compare the prognostic associations of lactate, albumin, and the lactate-albumin ratio (LAR) with mortality and MODS.
- To evaluate these biomarkers when measured early in the disease course of critically ill pediatric patients.
- To determine if LAR offers superior predictive value over individual lactate or albumin measurements.
Main Methods:
- Retrospective analysis of a national database (Health Facts) including 648 critically ill children admitted to U.S. PICUs (2009-2018).
- Lactate and albumin levels were measured within 6 hours of ICU admission.
- Statistical analysis compared biomarker levels and their association with mortality and MODS prevalence.
Main Results:
- Patients who died had significantly higher initial lactate, lower initial albumin, and higher LAR compared to survivors.
- Similar trends were observed for patients with MODS versus those without.
- The lactate-albumin ratio (LAR) demonstrated a higher odds ratio for death and MODS, and a greater area under the receiver operating characteristic (AUROC) curve for both outcomes compared to initial lactate alone.
Conclusions:
- The lactate-albumin ratio (LAR), measured early in critical illness, is significantly associated with mortality and MODS development in pediatric ICU patients.
- LAR provides superior prognostic information for mortality and MODS compared to initial lactate or albumin levels independently.
- LAR is a valuable and readily available early predictor of adverse outcomes in critically ill children.
Objectives:
To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients.
Design:
Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database.
Setting:
U.S. hospitals with PICUs.
Patients:
Children admitted to the ICU ( n = 648) from 2009 to 2018 who had lactate and albumin measured within 6 hours of admission.
Interventions:
None.
Measurements And Main Results:
A total of 648 admissions were included, with an overall mortality rate of 10.8% ( n = 70) and a MODS prevalence of 29.3% ( n = 190). Compared with survivors, deaths had higher initial lactates (7.3 mmol/L [2.6-11.7 mmol/L] vs 1.9 mmol/L [1.2-3.1 mmol/L]; p < 0.01), lower initial albumins (3.3 g/dL [2.7-3.8 g/dL] vs 4.2 g/dL [3.7-4.7 g/dL]; p < 0.01), and higher LARs (2.2 [1.0-4.2] vs 0.5 [0.3-0.8]; p < 0.01), with similar trends in patients with MODS versus those without MODS. LAR demonstrated a higher odds ratio (OR) for death than initial lactate alone (2.34 [1.93-2.85] vs 1.29 [1.22-1.38]) and a higher OR for MODS than initial lactate alone (2.10 [1.73-2.56] vs 1.22 [1.16-1.29]). Area under the receiver operating characteristic (AUROC) curve of LAR for mortality was greater than initial lactate (0.86 vs 0.82; p < 0.01). The LAR AUROC for MODS was greater than the lactate AUROC (0.71 vs 0.66; p < 0.01). Trends of lactate, albumin, and LAR for mortality were consistent across several diagnostic subgroups (trauma, primary respiratory failure, toxicology), but not all.
Conclusions:
LAR measured early in the course of critical illness is significantly associated with mortality and development of MODS when compared with initial lactate or initial albumin alone in critically ill pediatric patients.
