ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Critical Care
Volume 13 - 2025 | doi: 10.3389/fped.2025.1692874
Prognostic value of lactate dehydrogenase to albumin ratio for predicting mortality in critically ill pediatric patients: a retrospective cohort study
Provisionally accepted
- Suining Central Hospital, Suining, China
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Objective: Despite significant advances in pediatric intensive care, the early identification of high-risk critically ill children remains a persistent challenge. This study aimed to evaluate the association between the lactate dehydrogenase to albumin ratio (LAR) and mortality outcomes in critically ill pediatric patients. Methods: This retrospective cohort study analyzed data from the Pediatric Intensive Care (PIC) database (2010-2018) at the Children's Hospital of Zhejiang University School of Medicine. We included 8,782 critically ill patients aged ≥ 28 days with complete lactate dehydrogenase (LDH) and albumin (ALB) measurements. The LAR was calculated as serum LDH concentration divided by ALB concentration. The primary outcome was 30-day in-hospital mortality, while the secondary outcome was in-hospital mortality. Multivariate Cox proportional hazards regression models were constructed with adjustment for demographic characteristics, clinical parameters, and laboratory variables. Results: After full adjustment for covariates, LAR remained significantly associated with mortality risk. Each 10 U/g increase in LAR was associated with a 3% higher risk of 30-day in-hospital mortality (HR = 1.03, 95% CI: 1.01–1.04, P = 0.005) and a 4% higher risk of in-hospital mortality (HR = 1.04, 95% CI: 1.03–1.06, P < 0.001). Compared with the lowest tertile, the highest tertile had significantly higher mortality risk (30-day in-hospital mortality: HR = 3.72, 95% CI: 2.50–5.54; in-hospital mortality: HR = 2.68, 95% CI: 1.86–3.87; both P < 0.001). Receiver operating characteristic (ROC) analysis revealed that LAR's discriminative performance (AUC = 0.771 for 30-day in-hospital mortality; AUC = 0.763 for in-hospital mortality) outperformed that of either LDH or ALB alone. Conclusion: Elevated LAR independently predicts increased mortality risk in critically ill pediatric patients. As an easily calculated ratio derived from routine laboratory parameters, LAR represents a valuable prognostic tool for risk stratification in the pediatric intensive care setting.
Keywords: Lactate dehydrogenase to albumin ratio (LAR), pediatric critical care, Mortality prediction, prognostic biomarker, risk stratification
Received: 26 Aug 2025; Accepted: 17 Oct 2025.
Copyright: © 2025 Liu, Gou and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ping Yang, 13320245381@163.com
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