Association between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality

Association between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality Wei Liu, Li Zhou This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7799848/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Objective This study investigated the association between lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality. Methods A retrospective cohort study was conducted using data from a large pediatric electronic database that included 9,689 critically ill children. The primary exposure variable was the fi rst lactate-to-albumin ratio, which was analyzed as a continuous variable, while the outcome variable was in-hospital mortality. Multiple regression was employed to assess the relationship between lactate-to-albumin ratio and mortality, adjusting for potential confounders, such as length of hospital stay, sex, and other laboratory indicators. Results The results of the study revealed a significant positive correlation between the lactate-to-albumin ratio and in-hospital all-cause mortality. After adjustment, the regression coefficient (β) was4.05 (95% CI : 3.40 to 4.70, P < 0.01), indicating that a higher lactate-to-albumin ratio was associated with a high mortality risk. Tertile analysis showed that a high lactate-to-albumin ratio had significantly higher mortality rates than the low group, and sex-stratified analyses revealed a consistent positive correlation among both males and females.Additionally, and the association was most pronounced in all intensive care unit (ICU) patients. Conclusion This study highlights the potential of the lactate-to-albumin ratio as a predictive marker for critically ill pediatric patients in intensive care units. The se findings underscore the importance of monitoring this ratio to evaluate patient risk and emphasize the need for further extensive multicenter studies to validate these findings. lactate-to-albumin ratio mortality ICU pediatric Figures Figure 1 Introduction Both lactate and albumin levels have been identified as significant biomarkers for predicting clinical outcomes [ 1 , 2 ] . Elevated lactate levels at the time of ICU admission correlate with increased mortality risk, particularly in patients with severe sepsis [ 3 , 4 ] . Hyperlactatemia has been consistently linked to worse outcomes, with studies showing significantly higher mortality rates in pediatric patients with elevated initial lactate levels, particularly in those exceeding 5 mmol/L [ 5 ] . Elevated lactate levels serve not only as markers for metabolic distress but also reflect the underlying pathophysiological processes, especially in the context of sepsis [ 6 ] . In addition, serum albumin levels provide critical insights into the nutritional status and inflammatory response of patients. Hypoalbuminemia has been associated with poor outcomes including prolonged hospitalization and elevated mortality rates among critically ill children [ 7 ] . Consequently, the relationship between lactate and albumin levels suggests a complex interaction in which both biomarkers can enhance prognostic assessments in pediatric intensive care settings. Recent investigations have indicated that the lactate -to-albumin ratio may serve as a particularly effective independent predictor of mortality, potentially outperforming the predictive capabilities of either marker in isolation [ 8 – 10 ] . This finding highlights the utility of integrating these markers into treatment protocols, allowing clinicians to stratify risk s and tailor interventions more effectively [ 11 ] . Currently, limited research exists on the association between the lactate-to-albumin ratio and mortality in pediatric populations. This study investigated the correlation between the lactate-to-albumin ratio and all-cause mortality in the pediatric intensive care unit to establish a scientific foundation for assessing severe prognosis. Research methods 1. Research design and data sources This study adopted a retrospective cohort study design, meticulously aiming to explore the intricate relationship between the first laboratory lactate-to-albumin ratio and in-hospital all-cause mortality of patients admitted to the pediatric intensive care unit, a critical area of research that could potentially influence clinical practices and patient outcomes. Additionally, we sought to analyze the potential impact of various factors, including sex and the specific type of ICU, on this significant association, thereby providing a more nuanced understanding of how these variables may interact and affect patient prognosis. The research data were derived from a large-scale pediatric electronic database that was meticulously developed by the esteemed Children's Hospital, Zhejiang University School of Medicine. This comprehensive database diligently records all clinical information pertaining to patients in the pediatric intensive care unit from the time of admission, capturing a wide array of relevant data points, thereby providing a reliable data support system for the study. This meticulous approach ensures that the findings are not only valid but also applicable to real-world clinical settings, ultimately contributing to the body of knowledge that informs best practices in pediatric critical care [ 12 ] . 2. Study population The study population consisted of pediatric patients admitted to the intensive care unit of Zhejiang University Children's Hospital between 2010 and 2018. Eligible participants were aged < 18 years and underwent the first lactate-to-albumin ratio assessment within 24 h of hospitalization. Individuals with incomplete medical records were excluded from this study. The final analysis included 9,689 patients. 3. Variable Definitions Exposure variable: The first laboratory lactate-to-albumin ratio was analyzed as a continuous variable. Outcome variable: The in-hospital all-cause mortality rate was represented by a binary variable. The death group was assigned a value of 1 and the survival group was assigned a value of 0. Other variables included patient sex (male/female), length of hospital stay, other laboratory indicators (such as white blood cell count, platelet count, lactate level), and ICU type (such as cardiac ICU, general intensive care unit, etc.). All laboratory test results were obtained at first time within 24-hour of admission. 4. Statistical analysis All statistical analyses were performed using R ( http://www.R-project.org , The R Foundation) and EmpowerStats software ( http://www.empowerstats.com , X&Y Solutions, Inc., Boston, MA). Descriptive statistical analysis was initially conducted to outline the fundamental characteristics of each variable. Subsequently, an independent-samples t-test was u sed to assess the disparity in the first lactate-to-albumin ratio between the survival and death groups, with a significance level set at P < 0 .05. A multiple regression model was constructed, treating the first lactate-to-albumin ratio as a continuous variable and adjusting for length of hospital stay, sex, and other laboratory indicators as covariates. The association between the lactate-to-albumin ratio and ICU mortality was assessed by examining the regression coefficient (β value) and the 95% confidence interval (CI). The first lactate-to-albumin ratio was categorized into low, medium, and high groups, and inter-group mortality variations were analyzed. Additional stratified analysis was performed by categorizing the study subjects based on sex and ICU type to investigate how the aforementioned relationships manifest in distinct subgroups. Statistical significance was set at P < 0.05 was deemed statistically significant. This study employed a systematic methodological approach to thoroughly investigate the potential correlation between the first lactate-to-albumin ratio and ICU patient mortality, with the goal of offering a reliable foundation for prognostic evaluation in clinical settings. Results In the study population, there was a significant difference in the first lactate-to-albumin between the death and survival groups (Table 1). The first lactate-to-albumin ratio in the death group was significantly lower than that in the survival group (the mean values were 0.07 ± 0.08 and 0.18 ± 0.30, P<0.01). In addition, there were significant differences in indicators such as white blood cell count, platelet count, and ALT level between the two groups. Table 1 Baseline characteristics of the study participants DEAD 0 1 P-value* Number 9085 604 lactate-to-albumin ratio 0.07 ± 0.08 0.18 ± 0.30 <0.01 WBC（10 9 /L） 12.10 ± 20.47 16.22 ± 36.43 <0.01 RBC（10 12 /L） 3.91 ± 0.84 3.89 ± 1.05 0.58 EUTROPHILS PERCENTAGE(%) 63.85 ± 18.62 57.50 ± 22.21 <0.01 PLATELET COUNT（10 12 /L） 269.26 ± 143.83 229.39 ± 157.34 <0.01 RDW(%) 14.82 ± 2.50 15.54 ± 2.53 <0.01 POTASSIUM(mmol/L) 3.78 ± 0.76 4.12 ± 1.14 <0.01 CALCIUMTOTAL(mmol/L) 1.18 ± 0.14 1.12 ± 0.20 <0.01 ALT(U/L) 54.85 ± 287.77 139.74 ± 598.89 <0.01 AST(U/L) 119.61 ± 647.15 372.56 ± 1442.71 <0.01 CREATININE(μmol/L) 19.64 ± 20.24 14.24 ± 22.16 <0.01 MICU_CODE - CICU 2004 (22.06%) 42 (6.95%) General ICU 1133 (12.47%) 190 (31.46%) NICU 2458 (27.06%) 179 (29.64%) PICU 1408 (15.50%) 143 (23.68%) SICU 2082 (22.92%) 50 (8.28%) Table 2: Through Mutiple regression analysis, the first lactate-to-albumin ratio as a continuous variable was positively correlated with ICU mortality. After adjusting for length of hospital stay, gender, and other laboratory indicators, the β value was 4.05 (95% CI: 3.40 to 4.70, P < 0.01), indicating that the higher the lactate-to-albumin ratio, the higher the risk of death. The first lactate-to-albumin ratio was divided into low, medium, and high groups tertiles. The findings indicated a significant increase in ICU mortality in the high groups compared to the low group. The adjusted β values of 0.83 and 1.30 (P < 0.01) provided additional evidence supporting a positive correlation between first lactate-to-albumin and mortality. Table 2 Mutiple regression analysis effect of first lactate-to-albumin on in-hospital all-cause mortality Exposure Non-adjusted Adjust I Adjust II lactate-to-albumin ratio 5.02 (4.44, 5.60) <0.01 4.98 (4.40, 5.56) <0.01 4.05(3.40, 4.70) <0.01 lactate-to-albumin ratio three group LOW 1 1 1 MIDDLE 0.16 (-0.10, 0.42) 0.23 0.15 (-0.10, 0.41) 0.24 0.11 (-0.15, 0.37) 0.40 HIGH 1.31(1.09, 1.53) <0.01 1.30(1.08, 1.52) <0.01 1.06(0.83, 1.30) <0.01 Non-adjusted mode adjusted for: None; Adjust I model adjusted for: AGES; GENDER; Adjust II mode adjusted for: AGES, GENDER, RDW, WBC, POTASSIUM, LACTATE, HOLESTEROLTOTAL; ALT; AST; CREATININE Figure 1 A showe a smoothed spline plot of the lactate-to-albumin ratio and in-hospital all-cause mortality. regardless of gender, the first lactate/albumin ratio, was significantly positively correlated with in-hospital all-cause mortality.Figure 1 B A showed a a smoothed spline plot of the lactate-to-albumin ratio and in-hospital all-cause mortality among different types of ICU, the positive correlation between the first lactate-to-albumin ratio and mortality was most significant in all ICU. Discussion In this study, we investigated the relationship between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality in a cohort of critically ill children, comprising a sample size of 9,689 patients. Our findings indicate a positive correlation between elevated lactate-to-albumin ratio ratios and in-hospital all-cause mortality, which persisted even after adjusting for various confounders, including length of hospital stay, sex, and other laboratory indicators. Specifically, the regression analysis yielded the β value was 4.05 (95% CI: 3.40 to 4.70, P < 0.01), indicating that higher lactate-to-albumin ratio were significantly associated with a greater risk of in-hospital mortality. Tertile analysis further revealed that a higher lactate-to-albumin ratio corresponded to markedly elevated mortality rates compared to those with lower ratios, suggesting that the lactate-to-albumin ratio may serve as a critical prognostic marker in this setting. Notably, sex-stratified analyses showed consistent associations across both males and females, with the most pronounced effects observed in all ICU patients. The mechanisms underlying the observed association between the lactate -albumin ratio and mortality likely revolve around the metabolic and inflammatory states represented by these biomarkers [ 13 – 15 ] . Lactate is typically elevated in states of hypoperfusion and tissue hypoxia, indicative of metabolic stress or sepsis, whereas albumin serves as a vital protein reflective of nutritional status and inflammatory response. Uncontrolled pro-inflammatory cytokine release during severe infections can lead to decreased albumin synthesis and increased catabolism, complicating patient outcomes further [ 16 , 17 ] . Therefore, the combination of elevated lactate and low albumin levels may provide critical insight s into the pathophysiological state of critically ill patients, with a higher lactate-to-albumin ratio suggesting compounded insult and systemic derangement that worsens outcomes [ 18 ] . The findings of this study align with those of previous studies, suggesting that the lactate-to-albumin ratio is a promising predictor of mortality in diverse critically ill cohorts. For instance, Moustafa et al. and Wang et al. demonstrated similar associations, indicating that the lactate-to-albumin ratio is effective in differentiating between survivors and non-survivors in the PICU [ 19 ] . Moreover, these studies have reported that the lactate-to-albumin ratio is superior to lactate or albumin levels alone when assessing prognosis in critically ill pediatric patients, highlighting its robust discriminative power [ 20 ] . However, our study’s findings are in contrast to those in the literature, suggesting that not all studies observed significant correlations between the lactate-to-albumin ratio and mortality across all pediatric patient populations. Studies evaluating acute respiratory distress syndrome (ARDS) or those restricted to certain diagnostic categories may exhibit different results, where factors like underlying chronic conditions or clinical interventions may influence outcomes differently [ 21 , 22 ] . The variation in findings underscores the need to consider the clinical context and specific patient populations when interpreting the predictive value of the lactate-to-albumin ratio. The limitations of this study should be acknowledged. The retrospective nature of the analysis restricts causal inferences, and the potential biases inherent in electronic health records may affect data accuracy. Furthermore, while the sample size was substantial, certain confounders unrelated to the lactate-to-albumin ratio, including variations in treatment protocols and presence of comorbidities, were not controllable within the scope of the study. Future research should focus on prospective designs and include a more diverse range of clinical settings to validate the applicability of the lactate-to-albumin ratio as a universal prognostic tool in pediatric critical care [ 23 ] . In conclusion, an elevated lactate-to-albumin ratio at admission to the PICU was significantly associated with increased in-hospital all-cause mortality among critically ill children. This study reinforces the importance of integrating lactate-to-albumin ratio assessments into clinical practice as a potential predictive tool, allowing for improved risk stratification and optimizing patient management strategies in high-acuity settings. Declarations Ethics statement Studies involving human participants were reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University. Written informed consent for participation was not provided by the participants’ legal guardians/next of kin because: The requirement for informed consent was not required due to the retrospective nature of the study and containing no individual information. Competing interests The authors have no relevant financial or non-financial interests to disclose. Clinical Trial Number Clinical trial number: not applicable. Funding This work has no financial support Author Contribution Wei Liu analyzed the data, drafted the manuscript, contributed to the study design, and revised the article. Wei Liu and Li Zhou contributed to the conception, design, and revision of the manuscript. All the authors have read and approved the final manuscript. Data Availability Publicly available datasets were analyzed in this study. These data are available at http://pic.nbscn.org// References Bae S J, Namgung M, Jung K Y, et al. Lactate to albumin ratio as a prognosis predictor in gastrointestinal bleeding in the emergency department[J]. Intern Emerg Med, 2025,20(3):877-885. https://pubmed.ncbi.nlm.nih.gov/39060871/ Cakir E, Turan I O. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis[J]. Scand J Clin Lab Invest, 2021,81(3):225-229.https://pubmed.ncbi.nlm.nih.gov/33745405/ Colak M, Arda K M, Guven R, et al. 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Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome[J]. J Clin Anesth, 2024,99:111632. https://pubmed.ncbi.nlm.nih.gov/39326299/ Yin M, Si L, Qin W, et al. Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study[J]. J Intensive Care Med, 2018,33(12):687-694. https://pubmed.ncbi.nlm.nih.gov/28013574/ Erstad B L. Albumin disposition in critically Ill patients[J]. J Clin Pharm Ther, 2018,43(5):746-751. https://pubmed.ncbi.nlm.nih.gov/29969519/ Wang G, Liu J, Xu R, et al. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children[J]. BMC Pediatr, 2022,22(1):725. https://pubmed.ncbi.nlm.nih.gov/36539725/ Moustafa A A, Antonios M A, Abdellatif E M, et al. Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt[J]. Turk J Pediatr, 2018,60(6):691-701. https://pubmed.ncbi.nlm.nih.gov/31365206/ Bou C R, Jamali S, Sabra M, et al. Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department[J]. Front Med (Lausanne), 2020,7:550182. https://pubmed.ncbi.nlm.nih.gov/33072780/ Scott H F, Brou L, Deakyne S J, et al. Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children[J]. JAMA Pediatr, 2017,171(3):249-255. https://pubmed.ncbi.nlm.nih.gov/28068437/ Oh T K, Song I A, Lee J H. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis[J]. Sci Rep, 2018,8(1):14977. https://pubmed.ncbi.nlm.nih.gov/30297724/ Yue C, Zhang C, Ying C, et al. Reduced serum cholinesterase is an independent risk factor for all-cause mortality in the pediatric intensive care unit[J]. Front Nutr, 2022,9:809449. https://pubmed.ncbi.nlm.nih.gov/36505241/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 24 Nov, 2025 Reviewers agreed at journal 17 Nov, 2025 Reviewers invited by journal 10 Nov, 2025 Editor invited by journal 13 Oct, 2025 Editor assigned by journal 11 Oct, 2025 Submission checks completed at journal 11 Oct, 2025 First submitted to journal 07 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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1","display":"","copyAsset":false,"role":"figure","size":127879,"visible":true,"origin":"","legend":"\u003cp\u003ea, b Associations between the lactate-to-albumin ratio and in-hospital all-cause mortality stratified by gender/types of \u0026nbsp;ICU.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7799848/v1/7734da5b711f41ee883cac2b.png"},{"id":96369353,"identity":"938bf529-efdb-4d5e-9ac5-abe50026fae7","added_by":"auto","created_at":"2025-11-20 10:20:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":561039,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7799848/v1/19556080-f5f6-49e8-a214-8dd24201cee6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBoth lactate and albumin levels have been identified as significant biomarkers for predicting clinical outcomes\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e. Elevated lactate levels at the time of ICU admission correlate with increased mortality risk, particularly in patients with severe sepsis\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Hyperlactatemia has been consistently linked to worse outcomes, with studies showing significantly higher mortality rates in pediatric patients with elevated initial lactate levels, particularly \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein those exceeding 5 mmol/L\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Elevated lactate levels serve not only as markers for metabolic distress but also reflect the underlying pathophysiological processes, especially in the context of sepsis\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e \u003cb\u003e.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn addition, serum albumin levels provide critical insights into the nutritional status and inflammatory response of patients. Hypoalbuminemia has been associated with poor outcomes including prolonged hospitalization and elevated mortality rates among critically ill children \u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Consequently, the relationship between lactate and albumin levels suggests a complex interaction in which both biomarkers can enhance prognostic assessments in pediatric intensive care settings.\u003c/p\u003e\u003cp\u003eRecent investigations \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ehave indicated that the lactate\u003c/span\u003e-to-albumin ratio may serve as a particularly effective independent predictor of mortality, potentially outperforming the predictive capabilities of either marker in isolation\u003csup\u003e[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e–\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. This finding highlights the utility of integrating these markers into treatment protocols, allowing clinicians to stratify risk\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es and tailor interventions more effectively\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e. Currently, limited research exists on the association between the lactate-to-albumin ratio and mortality in pediatric populations. This study investigated the correlation between the lactate-to-albumin ratio and all-cause mortality in the pediatric intensive care unit \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eto establish a scientific foundation for assessing severe prognosis.\u003c/span\u003e\u003c/p\u003e\n\n\n\n\n\n\n\n"},{"header":"Research methods","content":"\u003ch3\u003e1. Research design and data sources\u003c/h3\u003e\u003cp\u003eThis study adopted a retrospective cohort study design, meticulously aiming to explore the intricate relationship between the first laboratory lactate-to-albumin ratio and in-hospital all-cause mortality of patients admitted to the pediatric intensive care unit, a critical area of research that could potentially influence clinical practices and patient outcomes. Additionally, we sought to analyze the potential impact of various factors, including sex and the specific type of ICU, on this significant association, thereby providing a more nuanced understanding of how these variables may interact and affect patient prognosis. The research data were derived from a large-scale pediatric electronic database that was meticulously developed by the esteemed Children's Hospital, Zhejiang University School of Medicine. This comprehensive database diligently records all clinical information pertaining to patients in the pediatric intensive care unit from the time of admission, capturing a wide array of relevant data points, thereby providing a reliable data support system for the study. This meticulous approach ensures that the findings are not only valid but also applicable to real-world clinical settings, ultimately contributing to the body of knowledge that informs best practices in pediatric critical care\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003ch3\u003e2. Study population\u003c/h3\u003e\u003cp\u003eThe study population consisted of pediatric patients admitted to the intensive care unit of Zhejiang University Children's Hospital between 2010 and 2018. Eligible participants were aged \u0026lt; 18 years and underwent \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe\u003c/span\u003e first lactate-to-albumin ratio assessment within 24 h of hospitalization. Individuals with incomplete medical records were excluded \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003efrom this study. The final analysis included 9,689\u003c/span\u003e patients.\u003c/p\u003e\u003ch3\u003e3. Variable Definitions\u003c/h3\u003e\u003cp\u003eExposure variable: The first laboratory lactate-to-albumin ratio was analyzed as a continuous variable.\u003c/p\u003e\u003cp\u003eOutcome variable: \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e in-hospital all-cause mortality rate was represented by a binary variable. The death group was assigned a value of 1 and the survival group was assigned a value of 0.\u003c/p\u003e\u003cp\u003eOther variables included patient sex (male/female), length of hospital stay, other laboratory indicators (such as white blood cell count, platelet count, lactate level), and ICU type (such as cardiac ICU, general intensive care unit, etc.). All laboratory test results were obtained at first time within 24-hour of admission.\u003c/p\u003e\u003ch3\u003e4. Statistical analysis\u003c/h3\u003e\u003cp\u003eAll statistical analyses were performed using R (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.R-project.org\u003c/span\u003e\u003cspan address=\"http://www.R-project.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, The R Foundation) and EmpowerStats software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.empowerstats.com\u003c/span\u003e\u003cspan address=\"http://www.empowerstats.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, X\u0026amp;Y Solutions, Inc., Boston, MA). \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDescriptive statistical analysis was initially conducted to outline the fundamental characteristics of each variable. Subsequently, an independent-samples t-test was u\u003c/span\u003esed to assess the disparity in the first lactate-to-albumin ratio between the survival and death groups, with a significance level set at P \u0026lt; 0 .05.\u003c/p\u003e\u003cp\u003eA multiple regression model was constructed, treating the first lactate-to-albumin ratio as a continuous variable and adjusting for length of hospital stay, sex, and other laboratory indicators as covariates. The association between the lactate-to-albumin ratio and ICU mortality was assessed by examining the regression coefficient (β value) and the 95% confidence interval (CI). The first lactate-to-albumin ratio was categorized into low, medium, and high groups, and inter-group mortality variations were analyzed.\u003c/p\u003e\u003cp\u003eAdditional stratified analysis was performed by categorizing the study subjects based on sex and ICU type to investigate how the aforementioned relationships manifest in distinct subgroups. Statistical significance was set at P \u0026lt; 0.05 was deemed statistically significant.\u003c/p\u003e\u003cp\u003eThis study employed a systematic methodological approach to thoroughly investigate the potential correlation between the first lactate-to-albumin ratio and ICU patient mortality, with the goal of offering a reliable foundation for prognostic evaluation in clinical settings.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eIn the study population, there was a significant difference in the\u0026nbsp;first\u0026nbsp;lactate-to-albumin\u0026nbsp;between the death and survival groups (Table 1). The\u0026nbsp;first\u0026nbsp;lactate-to-albumin ratio in the death group was significantly lower than that in the survival group (the mean values were 0.07 \u0026plusmn; 0.08 and 0.18 \u0026plusmn; 0.30, P\u0026lt;0.01). In addition, there were significant differences in indicators such as white blood cell count, platelet\u0026nbsp;count, and\u0026nbsp;ALT\u0026nbsp;level between the two groups.\u003c/p\u003e\n\u003cp\u003eTable 1\u0026nbsp;\u0026nbsp;Baseline characteristics of the study participants\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"632\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eDEAD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003eP-value*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e9085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003elactate-to-albumin ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e0.07 \u0026plusmn; 0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e0.18 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eWBC（10\u003csup\u003e9\u003c/sup\u003e/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e12.10 \u0026plusmn; 20.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e16.22 \u0026plusmn; 36.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eRBC（10\u003csup\u003e12\u003c/sup\u003e/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e3.91 \u0026plusmn; 0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e3.89 \u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eEUTROPHILS PERCENTAGE(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e63.85 \u0026plusmn; 18.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e57.50 \u0026plusmn; 22.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003ePLATELET COUNT（10\u003csup\u003e12\u003c/sup\u003e/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e269.26 \u0026plusmn; 143.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e229.39 \u0026plusmn; 157.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eRDW(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e14.82 \u0026plusmn; 2.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e15.54 \u0026plusmn; 2.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003ePOTASSIUM(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e3.78 \u0026plusmn; 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e4.12 \u0026plusmn; 1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eCALCIUMTOTAL(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1.18 \u0026plusmn; 0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1.12 \u0026plusmn; 0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eALT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e54.85 \u0026plusmn; 287.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e139.74 \u0026plusmn; 598.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eAST(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e119.61 \u0026plusmn; 647.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e372.56 \u0026plusmn; 1442.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eCREATININE(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e19.64 \u0026plusmn; 20.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e14.24 \u0026plusmn; 22.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eMICU_CODE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eCICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e2004 (22.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e42 (6.95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eGeneral ICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1133 (12.47%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e190 (31.46%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003eNICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e2458 (27.06%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e179 (29.64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 258px;\"\u003e\n \u003cp\u003ePICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1408 (15.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e143 (23.68%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2082 (22.92%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e50 (8.28%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2: Through Mutiple \u0026nbsp;regression analysis, the first lactate-to-albumin ratio as a continuous variable was positively correlated with ICU mortality. After adjusting for length of hospital stay, gender, and other laboratory indicators, the \u0026beta; value was 4.05 (95% CI: 3.40 to 4.70, P \u0026lt; 0.01), indicating that the higher the lactate-to-albumin ratio, the higher the risk of death. The first lactate-to-albumin ratio was divided into low, medium, and high groups tertiles. The findings indicated a significant increase in ICU mortality in the high groups compared to the low group. The adjusted \u0026beta; values of 0.83 and 1.30 (P \u0026lt; 0.01) provided additional evidence supporting a positive correlation between first lactate-to-albumin and mortality.\u003c/p\u003e\n\u003cp\u003eTable 2\u0026nbsp;Mutiple \u0026nbsp;regression analysis\u0026nbsp;effect of \u0026nbsp;first lactate-to-albumin on in-hospital all-cause mortality\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"617\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eExposure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eNon-adjusted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eAdjust I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003eAdjust II\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003elactate-to-albumin ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e5.02 (4.44, 5.60) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e4.98 (4.40, 5.56) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e4.05(3.40, 4.70) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003elactate-to-albumin ratio three group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eLOW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eMIDDLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e0.16 (-0.10, 0.42) 0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e0.15 (-0.10, 0.41) 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e0.11 (-0.15, 0.37) 0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003eHIGH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1.31(1.09, 1.53) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1.30(1.08, 1.52) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 158px;\"\u003e\n \u003cp\u003e1.06(0.83, 1.30) \u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNon-adjusted mode adjusted for: None;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdjust I model adjusted for: AGES; GENDER;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdjust II mode adjusted for: AGES, GENDER, \u0026nbsp;RDW, \u0026nbsp;WBC, POTASSIUM, \u0026nbsp;LACTATE, HOLESTEROLTOTAL; \u0026nbsp;ALT; \u0026nbsp;AST; \u0026nbsp;CREATININE\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Figure 1 A showe a smoothed spline plot of the lactate-to-albumin ratio and in-hospital all-cause mortality. regardless of gender, the first lactate/albumin ratio, was significantly positively correlated with in-hospital all-cause mortality.Figure 1 B A showed a a smoothed spline plot of the lactate-to-albumin ratio and in-hospital all-cause mortality among different types of \u0026nbsp;ICU, the positive correlation between the first lactate-to-albumin ratio and mortality was most significant in all ICU.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we investigated the relationship between \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe lactate-to-albumin\u003c/span\u003e ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality in a cohort of critically ill children, comprising a sample size of 9,689 patients. Our findings indicate a positive correlation between elevated lactate-to-albumin ratio ratios and in-hospital all-cause mortality, which persisted even after adjusting for various confounders, including length of hospital stay, sex, and other laboratory indicators. Specifically, the regression analysis yielded the β value was 4.05 (95% CI: 3.40 to 4.70, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that higher lactate-to-albumin ratio were significantly associated with a greater risk of in-hospital mortality. Tertile analysis further revealed that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea higher lactate-to-albumin\u003c/span\u003e ratio corresponded to markedly elevated mortality rates compared to those with lower ratios, suggesting that the lactate-to-albumin ratio may serve as a critical prognostic marker in this setting. Notably, sex-stratified analyses showed consistent associations across both males and females, with the most pronounced effects observed in all ICU patients.\u003c/p\u003e\u003cp\u003eThe mechanisms underlying the observed association between \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe lactate\u003c/span\u003e-albumin ratio and mortality likely revolve around the metabolic and inflammatory states represented by these biomarkers\u003csup\u003e[\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Lactate is typically elevated in states of hypoperfusion and tissue hypoxia, indicative of metabolic stress or sepsis, whereas albumin serves as a vital protein reflective of nutritional status and inflammatory response. Uncontrolled pro-inflammatory cytokine release during severe infections can lead to decreased albumin synthesis and increased catabolism, complicating patient outcomes further \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Therefore, the combination of elevated lactate and low albumin levels may provide critical insight\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003es into the pathophysiological state of critically ill patients, with a higher lactate-to-albumin\u003c/span\u003e ratio suggesting compounded insult and systemic derangement that worsens outcomes\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe findings of this study align with \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethose of previous\u003c/span\u003e studies, suggesting \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethat the lactate-to-albumin\u003c/span\u003e ratio is a promising predictor of mortality in diverse critically ill cohorts. For instance, Moustafa et al. and Wang et al. demonstrated similar associations, indicating that the lactate-to-albumin ratio is effective in differentiating between survivors and non-survivors in \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe PICU\u003c/span\u003e\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Moreover, these studies have reported that the lactate-to-albumin ratio is superior to lactate or albumin levels alone when assessing prognosis in critically ill pediatric patients, highlighting its robust discriminative power\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eHowever, our study\u0026rsquo;s findings are in contrast to those \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein the literature, suggesting that not all studies observed significant correlations between the lactate-to-albumin\u003c/span\u003e ratio and mortality across all pediatric patient populations. Studies evaluating acute respiratory distress syndrome (ARDS) or those restricted to certain diagnostic categories may exhibit different results, where factors like underlying chronic conditions or clinical interventions may influence outcomes differently\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. The variation in findings underscores the need to consider \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe clinical context and specific patient populations when interpreting the predictive value of the lactate-to-albumin\u003c/span\u003e ratio.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe\u003c/span\u003e limitations of this study should be acknowledged. The retrospective nature of the analysis restricts causal inferences, and \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethe potential biases inherent in electronic health records may affect data accuracy. Furthermore, while the sample size\u003c/span\u003e was substantial, certain confounders unrelated to the lactate-to-albumin ratio, including variations in treatment protocols and presence of comorbidities, were not controllable within the scope \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eof the study. Future research should focus on prospective designs and include a more diverse range of clinical settings to validate the applicability of the lactate-to-albumin\u003c/span\u003e ratio as a universal prognostic tool in pediatric critical care\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eIn conclusion, an elevated lactate-to-albumin ratio at admission to the PICU was significantly associated with increased in-hospital all-cause mortality among critically ill children. This study reinforces the importance of integrating lactate-to-albumin ratio assessments into clinical practice as a potential predictive tool, allowing for improved risk \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003estratification and optimizing patient management strategies in high-acuity settings.\u003c/span\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics statement\u003c/h2\u003e\n\u003cp\u003eStudies involving human participants were reviewed and approved by the Ethics Committee of the West China Hospital of Sichuan University. Written informed consent for participation was not provided by the participants\u0026rsquo; legal guardians/next of kin because: The requirement for informed consent was not required due to the retrospective nature of the study and containing no individual information.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003ch2\u003eClinical Trial Number\u003c/h2\u003e\n\u003cp\u003eClinical trial number: not applicable.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis work has no financial support\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eWei Liu analyzed the data, drafted the manuscript, contributed to the study design, and revised the article. Wei Liu and Li Zhou contributed to the conception, design, and revision of the manuscript. All the authors have read and approved the final manuscript.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003ePublicly available datasets were analyzed in this study. These data are available at\u0026nbsp;http://pic.nbscn.org//\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e Bae S J, Namgung M, Jung K Y, et al. Lactate to albumin ratio as a prognosis predictor in gastrointestinal bleeding in the emergency department[J]. Intern Emerg Med, 2025,20(3):877-885. https://pubmed.ncbi.nlm.nih.gov/39060871/\u0026nbsp;\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Cakir E, Turan I O. Lactate/albumin ratio is more effective than lactate or albumin alone in predicting clinical outcomes in intensive care patients with sepsis[J]. Scand J Clin Lab Invest, 2021,81(3):225-229.https://pubmed.ncbi.nlm.nih.gov/33745405/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Colak M, Arda K M, Guven R, et al. 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Association between lactate-to-albumin ratio and 28-day ICU mortality in pediatric severe pneumonia patients[J]. PLoS One, 2025,20(9):e331486. https://pubmed.ncbi.nlm.nih.gov/40938884/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Wu R, Xing B, Zhou Z, et al. Lactate-to-albumin ratio and 28 day mortality in hypertensive patients with atrial fibrillation: a retrospective cohort study[J]. Eur J Med Res, 2025,30(1):845. https://pubmed.ncbi.nlm.nih.gov/40947484/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Wang H X, Huang X H, Ma L Q, et al. Association between lactate-to-albumin ratio and short-time mortality in patients with acute respiratory distress syndrome[J]. J Clin Anesth, 2024,99:111632. https://pubmed.ncbi.nlm.nih.gov/39326299/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Yin M, Si L, Qin W, et al. Predictive Value of Serum Albumin Level for the Prognosis of Severe Sepsis Without Exogenous Human Albumin Administration: A Prospective Cohort Study[J]. J Intensive Care Med, 2018,33(12):687-694. https://pubmed.ncbi.nlm.nih.gov/28013574/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Erstad B L. Albumin disposition in critically Ill patients[J]. J Clin Pharm Ther, 2018,43(5):746-751. https://pubmed.ncbi.nlm.nih.gov/29969519/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Wang G, Liu J, Xu R, et al. Lactate/albumin ratio as a predictor of in-hospital mortality in critically ill children[J]. BMC Pediatr, 2022,22(1):725. https://pubmed.ncbi.nlm.nih.gov/36539725/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Moustafa A A, Antonios M A, Abdellatif E M, et al. Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt[J]. Turk J Pediatr, 2018,60(6):691-701. https://pubmed.ncbi.nlm.nih.gov/31365206/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Bou C R, Jamali S, Sabra M, et al. Lactate/Albumin Ratio as a Predictor of In-Hospital Mortality in Septic Patients Presenting to the Emergency Department[J]. Front Med (Lausanne), 2020,7:550182. https://pubmed.ncbi.nlm.nih.gov/33072780/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Scott H F, Brou L, Deakyne S J, et al. Association Between Early Lactate Levels and 30-Day Mortality in Clinically Suspected Sepsis in Children[J]. JAMA Pediatr, 2017,171(3):249-255. https://pubmed.ncbi.nlm.nih.gov/28068437/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Oh T K, Song I A, Lee J H. Clinical usefulness of C-reactive protein to albumin ratio in predicting 30-day mortality in critically ill patients: A retrospective analysis[J]. Sci Rep, 2018,8(1):14977. https://pubmed.ncbi.nlm.nih.gov/30297724/\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Yue C, Zhang C, Ying C, et al. Reduced serum cholinesterase is an independent risk factor for all-cause mortality in the pediatric intensive care unit[J]. Front Nutr, 2022,9:809449. https://pubmed.ncbi.nlm.nih.gov/36505241/\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"lactate-to-albumin ratio, mortality, ICU, pediatric","lastPublishedDoi":"10.21203/rs.3.rs-7799848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7799848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eThis study investigated the association between lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA retrospective cohort study was conducted using data from a large pediatric electronic database that included 9,689 critically ill children. The primary exposure variable was the fi\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003erst\u003c/span\u003e lactate-to-albumin ratio, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewhich was analyzed as a continuous variable, while the outcome variable was in-hospital mortality. Multiple regression\u003c/span\u003e was employed to assess the relationship between lactate-to-albumin ratio and mortality, adjusting for potential confounders, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003esuch as\u003c/span\u003e length of hospital stay, sex, and other laboratory indicators.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe results of the study revealed a significant positive correlation between the lactate-to-albumin ratio and in-hospital all-cause mortality. After adjustment, the regression coefficient (β) was4.05 (95% \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCI\u003c/span\u003e: 3.40 to 4.70, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), indicating that \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ea higher\u003c/span\u003e lactate-to-albumin ratio was associated with a high mortality risk. Tertile analysis showed \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ethat a high\u003c/span\u003e lactate-to-albumin ratio had significantly higher mortality rates than the low group, and sex-stratified analyses revealed a consistent positive correlation among both males and females.Additionally, \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand the association was most pronounced in\u003c/span\u003e all intensive care unit (ICU) patients.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study highlights the potential of the lactate-to-albumin ratio as a predictive marker for critically ill pediatric patients in intensive care units. The\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ese findings underscore the importance of monitoring this ratio to evaluate patient risk and emphasize the need for further extensive\u003c/span\u003e multicenter studies to validate these findings.\u003c/p\u003e","manuscriptTitle":"Association between the lactate-to-albumin ratio at admission to the pediatric intensive care unit and in-hospital all-cause mortality","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 00:49:48","doi":"10.21203/rs.3.rs-7799848/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-11-24T17:26:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31994691349005840900677713069876622798","date":"2025-11-17T12:32:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T06:03:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T06:08:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-11T06:32:06+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-11T06:31:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-10-07T13:01:26+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"615f24c2-bc56-4095-bece-1ef3c2a052bd","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-11-20T00:49:48+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 00:49:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7799848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7799848","identity":"rs-7799848","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}