Lactate and lactate-albumin ratio as a predictor of outcome in pediatric sepsis – A prospective observational study

Objective: To compare the prognostic accuracy of serum lactate and lactate-albumin ratio (LAR) at 0, 6, and 24 h in pediatric sepsis. Materials and Methods: In this 22-month prospective observational study, 72 children aged 1 month–14 years with suspected sepsis were enrolled. Exclusion criteria included malignancy, chronic liver or renal disease, nephrotic syndrome, or metabolic disorders. Serum lactate and albumin were measured at admission and 6 and 24 h. The primary outcome was 28-day mortality. Diagnostic performance was determined using the area under the receiver operating curve analysis; sensitivity, specificity, and optimal cutoffs were calculated. Results: Mortality was 29.2%. At 24 h, serum lactate (cut-off ≥1.8 mmol/L) had an area under the receiver operating curve –0.974 (90.5% sensitivity, 96.1% specificity), and LAR (cut-off ≥0.6) had an area under the receiver operating curve –0.972 (95% sensitivity, 92% specificity). Earlier time points were less predictive. Conclusion: Both serum lactate and LAR at 24 h are highly accurate predictors of mortality in pediatric sepsis. In addition, LAR at all timepoints provides better diagnostic accuracy than lactate alone, and hence these low-cost markers are feasible for risk assessment in Indian pediatric intensive care unit settings.