Moustafa AA, Antonios MAM, Abdellatif EM, Hussain AH. Association of lactate/albumin ratio level to organ failure and mortality in severe sepsis in a pediatric intensive care unit in Egypt. Turk J Pediatr 2018; 60: 691-701.This study aimed at investigating the lactate to albumin ratio, as a newly introduced biomarker of multiple organ dysfunction syndrome (MODS) and mortality compared to the classic lactate clearance in pediatric patients. We designed a prospective cohort study and 155 patients with severe sepsis or septic shock admitted to a Pediatric Intensive Care Unit were included, starting from January 2016 to March 2017. The data of 119 patients who completed the study, were analyzed. Results revealed that lactate clearance (6h, 24h) was significantly lower and lactate/albumin ratio (0h, 6h, 24h) was significantly higher in patients who developed MODS and in those who passed away. The univariate logistic regression showed that both lactate clearance and lactate/albumin ratio were significant prognostic factors of MODS and mortality. According to the AUC, lactate/albumin ratio (0h, 6h, 24h) showed better discrimination of MODS development (with AUC of 0.729, 0.814, and 0.819, respectively) compared to lactate clearance (6h, 24h; AUC of 0.738, and 0.672, respectively). Again the lactate/albumin ratio (0h, 6h, 24h) showed better discriminatory power of mortality (0.681, 0.741, and 0.856, respectively) compared to the lactate clearance (6h, 24h; 0.638 and 0.77, respectively). The Youden Index specified a lactate/albumin ratio (0h, 6h, 24h) of 1.17, 1.07, and 1.1 to be the cut-off discriminating values, respectively. The Kaplan-Meier curves revealed that the cumulative of survival is significantly better for the group of patients with a lactate/albumin ratio less than the cut-off values. It was concluded that lactate/albumin ratio is a better discriminator of MODS development and mortality than lactate clearance in pediatric patients with severe sepsis or septic shock.