[A cohort study on the association between lactate to albumin ratio and 28-day in-hospital all-cause mortality in critically ill children].
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OBJECTIVE: To assess the association between the lactate to albumin ratio (LAR) and 28-day in-hospital all-cause mortality in critically ill children. METHODS: A retrospective cohort study was conducted. Children admitted to various intensive care units (ICU), aged≥28 days and ≤18 years in the Pediatric Intensive Care Database (PIC) from 2010 to 2018 were enrolled. Demographic data, ICU type, vital signs, comorbidities, the first laboratory parameters within 24 hours of admission, and outcomes were collected. The primary exposure variable was LAR. The primary outcome was 28-day in-hospital all-cause mortality. Children were divided into three groups based on LAR: LAR<0.03 group, 0.03≤LAR<0.06 group, and LAR≥0.06 group. Variables with significant differences in univariate analysis and potential risk factors were incorporated into multivariate Cox regression analysis. Risk models were constructed by adjusting for relevant covariates to evaluate the association between LAR and mortality. Kaplan-Meier survival curve for 28-day mortality and receiver operator characteristic curve (ROC curve) were plotted. Subgroup analyses were performed based on relevant covariates. In addition, sensitivity analyses were conducted by including children aged<28 days and excluding those with the length of ICU stay<48 hours to evaluate model robustness. RESULTS: A total of 7 523 children were included, with a median age of 1.4 (0.4, 4.5) years old, and 44.2% were female, 28-day in-hospital all-cause mortality was 4.5%. Among them, there were 2 055 cases in the group with LAR<0.03, 2 409 cases in the group with 0.03≤LAR<0.06, and 3 059 cases in the group with LAR≥0.06. Higher LAR was associated with increased 28-day all-cause mortality and prolonged hospital stay. After adjusting for potential confounders, LAR was independently associated with mortality risk. For every 0.1-unit increase in LAR, the risk of 28-day mortality increased by 30% [hazard ratio (HR)=1.30, 95% confidence interval (95%CI) was 1.23-1.38, P<0.001]. When analyzed as a categorical variable using the LAR<0.03 group as reference, children with LAR≥0.06 had a significantly higher mortality risk (HR=2.45, 95%CI was 1.73-3.46, P<0.001). Kaplan-Meier curve analysis showed lower 28-day cumulative survival in the LAR≥0.06 group (Log-rank test: χ 2=182.60, P<0.001). ROC curve analysis indicated that the area under the curve (AUC) for LAR prediction of 28-day mortality was 0.705 (95%CI was 0.673-0.737), with a optimal cut-off value of 0.045. The sensitivity was 62.1% and the specificity was 68.4%. Subgroup analysis of relevant factors showed no interactions were observed in other indicators such as age, sepsis, pneumonia, encephalitis, and malignant tumors, except for interaction between glucose, gender, and 28-day mortality (P for interaction <0.05). Results from both sensitivity analyses remained consistent, indicating a stable association between LAR and adverse outcomes. CONCLUSIONS: LAR is independently associated with 28-day in-hospital all-cause mortality in critically ill children. Critically ill children with elevated LAR levels have a poorer clinical prognosis.