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Lactate-albumin ratio measurements at multiple time points and their association with outcome in pediatric trauma: a
Kazim Zararci1, Hatice Feray Ari2
1Department of Pediatric Intensive Care, Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Turkey.
Insights
The lactate-to-albumin ratio (L/A) effectively predicts mortality in pediatric trauma patients. L/A measurements at 24 and 48 hours show good discriminatory performance for predicting outcomes in critically injured children.
Area of Science:
- Pediatric critical care
- Trauma research
- Biomarker discovery
Background:
- Childhood trauma is a major cause of death globally.
- Systemic inflammation following trauma necessitates rapid pediatric assessment.
- Lactate and serum albumin are key indicators of hypoxia and inflammatory response, respectively.
Purpose of the Study:
- To investigate the association between the lactate-to-albumin ratio (L/A) and mortality in pediatric trauma patients.
- To evaluate L/A measurements at 0, 24, and 48 hours post-trauma.
- To assess L/A's discriminatory performance for predicting mortality.
Main Methods:
- Retrospective observational cohort study of 115 pediatric trauma patients (1 month-18 years).
- Analysis of paired lactate-to-albumin ratio (L/A) data at 0, 24, and 48 hours.
- Receiver operating characteristic (ROC) analysis to assess L/A's ability to discriminate mortality.
Main Results:
- Mortality rate was 11.3% among the studied pediatric trauma patients.
- L/A values were significantly higher in non-survivors compared to survivors at all time points.
- ROC analysis indicated good discriminatory performance for L/A at 24 and 48 hours.
Conclusions:
- Lactate-to-albumin ratio (L/A) measurements at 24 and 48 hours are associated with mortality in pediatric trauma.
- L/A shows promise as a complementary biomarker in pediatric trauma care.
- Further research is needed to clarify L/A's incremental value over lactate alone.
Background:
Childhood trauma is one of the leading global causes of morbidity and mortality. Due to the trauma-triggered systemic inflammatory response, simple laboratory parameters are important for rapid assessment in pediatrics. Lactate is an indicator of hypoxia, serum albumin is a negative acute phase reactant, and the lactate-to-albumin ratio (L/A) has been reported to be associated with trauma severity and mortality. The aim of this study was to evaluate the association between L/A measurements at 0, 24, and 48 h and PICU mortality in pediatric trauma patients. Secondary outcomes were recorded and described but were not included as primary analytical endpoints.
Methods:
This retrospective observational cohort study included patients aged 1 month-18 years admitted to a tertiary PICU due to trauma between May 2023 and September 2025. Only cases with complete paired data at 0, 24, and 48 h were analyzed. Demographic and clinical variables, laboratory parameters, clinical scores, and Pediatric Risk of Mortality Score III (PRISM III), Pediatric Trauma Score (PTS), Shock Index (SI), Shock Index, Pediatric Age-Adjusted (SIPA), and Glasgow Coma Scale (GCS) were recorded. Receiver operating characteristic (ROC) analysis assessed the ability of L/A measured at 0, 24, and 48 h, together with comparator measures, to discriminate mortality.
Results:
Among 115 patients, mortality was 11.3%. L/A values at 0, 24, and 48 hours were significantly higher in non-survivors than survivors. ROC analysis showed good discriminatory performance for both lactate and L/A at 24 and 48 hours. Although L/A demonstrated numerically higher area under the curve (AUC) values, no formal statistical comparison between lactate and L/A was performed.
Conclusion:
L/A measurements at 24 and 48 h showed good discriminatory performance and were associated with mortality in pediatric trauma. L/A may serve as a complementary biomarker alongside established clinical scoring systems, although its incremental value over lactate alone remains uncertain.
