Lactate/albumin ratio as an independent predictor of mortality in pediatric trauma patients admitted to a pediatric intensive care unit

Early identification of pediatric trauma patients at high risk of mortality remains challenging despite advances in critical care management. Systemic inflammatory response and subsequent organ dysfunction play a central role in trauma-related mortality. Recently, the lactate/albumin ratio (LAR) and inflammatory biomarkers such as the neutrophil-to-lymphocyte ratio (NLR) have emerged as potential prognostic indicators; however, their independent predictive value in pediatric trauma remains incompletely defined. In this retrospective cohort study, 272 pediatric trauma patients admitted to a tertiary pediatric intensive care unit (PICU) were screened. After excluding 28 patients who died within the first 24 h and 34 patients with incomplete laboratory data, 210 patients were included in the final analysis. Demographic, clinical, and laboratory parameters were collected at admission. The primary outcome was in-hospital mortality. Receiver operating characteristic (ROC) curve analysis and multivariable logistic regression were performed to evaluate independent predictors of mortality. Among 210 patients, 27 (12.9%) died during PICU stay. Non-survivors had significantly higher PRISM III scores and prolonged mechanical ventilation duration. LAR demonstrated the highest discriminatory performance for mortality (AUC 0.918, 95% CI: 0.839-0.978), followed by NLR (AUC 0.900) and PRISM III score (AUC 0.884). In multivariable analysis, LAR emerged as a prominent independent predictor of mortality (OR 12.22, 95% CI: 3.08-48.49, p < 0.001), while NLR and PRISM III score remained independently associated with adverse outcomes. CONCLUSION: The lactate/albumin ratio was independently associated with in-hospital mortality and improved risk discrimination when added to PRISM III in this selected cohort of pediatric trauma patients. As a simple and readily available biomarker, LAR may complement established severity scoring systems and support early risk stratification, although external validation is required before clinical application. WHAT IS KNOWN: • Serum lactate and inflammatory indices such as the neutrophil-to-lymphocyte ratio are associated with poor outcomes in pediatric trauma, but their independent prognostic value is incompletely defined. • Established severity scores like PRISM III predict mortality but may not fully capture the combined effects of tissue hypoperfusion and inflammation. WHAT IS NEW: • The lactate/albumin ratio independently predicted in-hospital mortality and showed the highest discrimination (AUC 0.918) among tested markers in PICU-admitted pediatric trauma patients. • Adding the lactate/albumin ratio to PRISM III improved risk discrimination, supporting its role as a simple adjunct forearly stratification pending external validation.