Analisis Rasio Laktat/Albumin Sebagai Prediktor Mortalitas Sepsis Anak Di Pediatric Intensive Care Unit (PICU) Rumah Sakit Umum Pusat Haji Adam Malik Medan

Abstract

Background: Pediatric sepsis is still a major health problem worldwide due to high mortality and morbidity. The inflammatory process in sepsis causes an increase in lactate and a decrease in albumin, which affects the lactate/albumin ratio. Previous studies showed that the lactate/albumin ratio is a potentially useful biomarker for microcirculatory injury in sepsis.

Objective: This study aimed to analyze the lactate/albumin ratio as a predictor of pediatric sepsis mortality in Pediatric Intensive Care Unit (PICU) at Adam Malik Hospital.

Methods: This was an observational study involving 92 children diagnosed with sepsis who were admitted to PICU of Adam Malik Hospital Medan from January 2023 to September 2024, aged 1 month to 18 years. Laboratory parameters, including lactate and albumin levels, were measured within 24 hours of PICU admission. The lactate/albumin ratio and other variables were compared between survivors and non-survivors. Comparisons between independent groups were made using the unpaired t-test for normally distributed or Mann-Whitney U test for non-normally distributed continuous variables. The categorical data were compared by chi-square or Fisher exact test as appropriate. Receiver operating characteristic (ROC) curve analysis was performed to determine cut-off values for lactate/ albumin ratio for the prediction of mortality.

Results: The median lactate/albumin ratio in this study was 0.39 (range 0.11 - 5.4). The lactate/albumin ratio levels were significantly higher in non-survivors compared to survivors (p=0.007). The lactate level was significantly higher (p= 0.02), while albumin was significantly lower (p=0.009) in non-survivors compared to survivors. The optimal lactate/albumin ratio cut-off value was 0.438 (sensitivity 54.1% and specificity 80.6%). The area under the curve in ROC analysis for lactate/albumin ratio was 0.672 (p=0.007).

Conclusion: The ratio of lactate/albumin was a significant predictor of pediatric sepsis mortality.