517: The Lactate-Albumin Ratio as a Marker of in-Hospital Mortality in Critically Ill Pediatric Patients

The Lactate-Albumin Ratio Predicts Multiple Organ Dysfunction Syndrome and Death, But Is It Ready to Use?*

“…This study by Ray et al (6), strongly supports the view that LAR is likely to be a better discriminator, than lactate or albumin alone. As the authors state “future studies evaluating outcomes of critically ill patients based on distinctive high and low LAR cut points in addition to a prospective evaluation of the LAR would further validate the ratio’s utility as a prognostic tool.”…”

“…Likewise, children with sepsis/septic shock with a raised LAR were recognized to have an increased risk of death. However, in this issue of Pediatric Critical Care Medicine , Ray et al (6), in a very well written article, have shown that an increased LAR is a predictor of MODS/death in children admitted to PICU with a variety of conditions including sepsis, pneumonia, trauma, toxicologic insult, and other diseases.…”

“…Ray et al (6) studied a U.S. database-Health Facts and found 648 admissions to general PICU; 190 subsequently developed MODS and 70 died. In children who developed MODS or died, the initial lactate was higher, the albumin lower and consequently, the LAR higher.…”

“…Consequently, we acknowledge this deficiency and accept the statistical imperfection. Ray et al (6) only evaluated an initial, single measurement of LAR. As is well known by the authors, a time series analysis is more accurate than a single point measurement (9, 10); hence, future studies will also look at change in LAR over 24 hours and are likely to show that failure to improve (similar to failure to clear lactate) will be associated with a worse prognosis than if improvement occurs.…”

“…T he management of post-extubation upper airway obstruction (UAO) is a common and costly problem that may put pediatric patients at increased risk for reintubation, morbidity, and mortality in PICUs (1)(2)(3). Existing literature suggests risk factors for developing UAO after ventilator liberation include age (4, 5), pre-intubation UAO (5,6), multiple attempts or traumatic intubation, and the absence of air leak at the time of intubation (7). The recent pediatric ventilator liberation guidelines from the Pediatric Acute Lung Injury and Sepsis Investigators network offer guidance around periextubation UAO, including an air leak test as part of an extubation readiness test bundle and administering dexamethasone greater than 6 hours prior to…”