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Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients
Maria Camila Pérez1, Jaime Fernández-Sarmiento2, Juan David Bustos1
1Department of Critical Care Medicine and Pediatrics, Fundación Cardioinfantil- Instituto de Cardiología, Universidad de La Sabana, Campus Universitario del Puente del Común, Km 7 Autopista Norte de Bogotá, Chía - Cundinamarca, Bogotá, Colombia.
Insights
In pediatric critical illness, an elevated lactate/albumin ratio (LAR) indicates microcirculation disorders and increased mortality risk in sepsis. A normal LAR suggests less risk of microcirculatory injury.
Area of Science:
- Pediatric Critical Care Medicine
- Sepsis Pathophysiology
- Microcirculation Research
Background:
- A high lactate/albumin ratio (LAR) in pediatric critical illness correlates with increased mortality.
- The link between elevated LAR and microcirculatory dysfunction in pediatric sepsis remains unclear.
Purpose of the Study:
- To investigate the association between elevated lactate/albumin ratio (LAR) and microcirculatory disorders in children with sepsis.
- To determine if LAR can serve as a biomarker for microcirculatory injury in pediatric sepsis.
Main Methods:
- Longitudinal retrospective study of 178 children in the pediatric intensive care unit (PICU) from January 2021 to January 2024.
- Simultaneous measurement of serum lactate, albumin, and sublingual microcirculation using video microscopy.
- Sepsis and septic shock assessed using the Phoenix Sepsis Score.
Main Results:
- Elevated LAR was associated with remote sepsis (aOR 6.87) and increased mortality (aOR 3.55).
- Children with elevated LAR exhibited more microvascular blood flow abnormalities and lower capillary density.
- A normal LAR was linked to a reduced risk of microcirculatory injury (aOR 0.77).
Conclusions:
- In pediatric sepsis, an elevated lactate/albumin ratio is significantly associated with microcirculation abnormalities, including reduced microvascular density and impaired flow.
- The lactate/albumin ratio shows potential as a valuable biomarker for detecting microcirculatory injury in pediatric sepsis.
- A normal LAR is protective, indicating a lower risk of microcirculatory compromise.
Abstract:
A lactate/albumin ratio (LAR) greater than 0.5 measured early in the course of pediatric critical illness is associated with greater mortality. Whether the elevated LAR can be explained by microcirculation disorders in children with sepsis is not known. In this longitudinal retrospective study (January 2021-January 2024), serum albumin and lactate were measured on admission to the pediatric intensive care unit (PICU), with sublingual video microscopy performed simultaneously to measure microcirculation. A total of 178 children were included, 37% of whom had septic shock measured with the Phoenix Sepsis Score. Patients with remote sepsis had greater odds of an elevated LAR (aOR 6.87: 95% CI 1.98-23.73; p < 0.01). Children with an elevated LAR had more microvascular blood flow abnormalities (aOR 1.31 95% CI 1.08-1.58; p < 0.01), lower 4-6-micron capillary density (aOR 1.03 95% CI 1.01-1.05; p < 0.01) and greater odds of dying (aOR 3.55 95% CI 1.21-10.38; p = 0.02) compared to those with a low LAR. We found no association between LAR and endothelial glycocalyx degradation. A normal LAR is associated with less risk of microcirculatory injury (aOR 0.77 95% CI 0.65-0.93; p < 0.01). In children with sepsis, an elevated LAR is associated with microcirculation abnormalities (microvascular density and flow). The lactate/albumin ratio is a potentially useful biomarker for microcirculatory injury in sepsis.
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