The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients*

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.